Centers for Disease Control and Prevention
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| |RRC APPLICATION FORM |
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|RESEARCH PROTOCOL | |
|NUMBER: 2009-004 |FOR OFFICE USE ONLY |
| |RRC Approval: | Yes / | No |Date: 2 Feb 2009 |
| |ERC Approval: | Yes / | No |Date: 31 Mar 2009 |
| |AEEC Approval: | Yes / | No |Date: |
|Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: |
|The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) |
|Short title (in 50 characters including space): Bangladesh secondary transmission handwashing protocol |
|Theme: (Check all that apply) | |
| |Environmental Health |
|Nutrition |Health Services |
|Emerging and Re-emerging Infectious Diseases |Child Health |
|Population Dynamics |Clinical Case Management |
|Reproductive Health |Social and Behavioural Sciences |
|Vaccine Evaluation | |
|HIV/AIDS | |
|Key words: Influenza, secondary transmission, handwashing, Bangladesh |
|Relevance of the Protocol: |
|Influenza is an important cause of respiratory illnesses among children and adults in Bangladesh. The next influenza pandemic is expected to spread |
|rapidly in resource-poor settings. Influenza viruses spread from human-to-human via large respiratory droplets. The greatest risk of transmission from |
|personal contact comes from the household contact of an index case. However, there is no published data available on the secondary attack ratio or the |
|risk factors for secondary transmission of influenza among household contacts from the index case-patients of low-income countries. Moreover, we do not|
|have any evidence whether promoting handwashing with soap can reduce the risk of secondary transmission of influenza among household contacts. The |
|proposed study will determine the secondary attack ratio and the risk factors for secondary transmission of influenza and assess the impact of |
|handwashing intervention on influenza transmission among household contacts in Bangladesh. |
|Centre’s Priority (as per Strategic Plan, to be imported from the attached Separate Word Sheet): |
|4.1 Define the epidemiology and burden of selected infectious diseases and identify effective strategies for prevention and control. |
|4.4 Enhance the capacity to investigate, study, and manage outbreaks of communicable diseases in the region. |
|Programmes: | |
| |Health and Family Planning Systems Programme |
|Child Health Programme |Population Programme |
|Nutrition Programme |Reproductive Health Programme |
|Programme on Infectious Diseases & Vaccine Science |HIV/AIDS Programme |
|Poverty and Health Programme | |
|Principal Investigator (Should be a Centre’s staff) | DIVISION: |
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|Dr. Stephen P. Luby |CSD LSD |
|Address (including e-mail address): |HSID PHSD |
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|Head, | |
|PIDVS, HSID, ICDDR,B. | |
|Mohakhali, Dhaka 1212 | |
|Email: sluby@ | |
|Co-Principal Investigator(s): Internal |
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|Co-Principal Investigator(s): External: |
|(Please provide full official address including e-mail address and Gender) |
|Pavani K. Ram, MD |
|Assistant Professor |
|Department of Social and Preventive Medicine |
|School of Public Health and Health Professions |
|University at Buffalo |
|3435 Main Street, Rm. 273 Farber Hall |
|Buffalo, NY 14214 |
|E-mail: pkram@buffalo.edu |
|Gender: Female |
|Co-Investigator(s): Internal: |
|Tasnim Azim, Eduardo Azizz-Baumgartner, W. Abdullah Brooks, Stephen Luby, Mustafizur Rahman and Rashid Uz Zaman |
|Co-Investigator(s): External |
|(Please provide full official address including e-mail address and Gender) |
|Joe Bresee, Influenza Division, CDC, 1600 Clifton road, Atlanta, GA 30333, USA. jsb6@. Male |
|Alicia Fry, Influenza Division, CDC, 1600 Clifton road, Atlanta, GA 30333, USA. agf1@. Female |
|Student Investigator(s): Internal (Centre’s staff): |
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|Student Investigator(s): External: |
|(Please provide full address of educational institution and Gender) |
|Margaret DiVita, PhD Candidate, Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, |
|3435 Main Street, Rm. 273 Farber Hall, Buffalo, NY 14214, mdivita@. Female |
|Country |
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|USA |
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|Contact person |
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|Pavani K. Ram, MD |
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|Department |
|(including Division, Centre, Unit) |
|Department of Social and Preventive Medicine |
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|Institution |
|(with official address) |
|School of Public Health and Health Professions |
|University at Buffalo |
|3435 Main Street, Rm. 273 Farber Hall |
|Buffalo, NY 14214 |
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|Directorate |
|(in case of GoB i.e. DGHS) |
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|Ministry (in case of GoB) |
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|Collaborating Institute(s): Please Provide full address |
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|Institution # 1 |
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|Institution # 2 |
|Country |
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|USA |
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|Contact person |
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|Alicia Fry, MD MPH |
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|Department |
|(including Division, Centre, Unit) |
|Influenza Division, National Centre for Immunization and Respiratory Diseases |
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|Institution |
|(with official address) |
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|Centers for Disease Control and Prevention |
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|Directorate |
|(in case of GoB i.e. DGHS) |
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|Ministry (in case of GoB) |
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|Institution # 3 |
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|Country |
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|Contact person |
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|Department |
|(including Division, Centre, Unit) |
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|Institution |
|(with official address) |
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|Directorate |
|(in case of GoB i.e. DGHS) |
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|Ministry (in case of GoB) |
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|Note: If more than 3 collaborating institutions are involved in the research protocol, additional block(s) can be inserted to mention its/there |
|particular(s). |
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|Population: Inclusion of special groups (Check all that apply): |
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|Sex |
|Male |
|Female |
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|Age |
|0 – 4 years |
|5 – 9 years |
|10 – 19 years |
|20 – 64 years |
|65 + |
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|Pregnant Women |
|Fetuses |
|Prisoners |
|Destitutes |
|Service Providers |
|Cognitively Impaired |
|CSW |
|Others (specify ) |
|Animal |
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|NOTE It is the policy of the Centre to include men, women, and children in all research projects involving human subjects unless a clear and |
|compelling rationale and justification (e.g. gender specific or inappropriate with respect to the purpose of the research) is there. Justification |
|should be provided in the `Sample Size’ section of the protocol in case inclusiveness of study participants is not proposed in the study. |
|Project/study Site (Check all the apply): | |
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|Dhaka Hospital |Mirsarai |
|Matlab Hospital |Patyia |
|Matlab DSS Area |Other areas in Bangladesh: Jahurul Islam Medical College Hospital, |
|Matlab non-DSS Area |Kishorgonj |
|Mirzapur |Outside Bangladesh |
|Dhaka Community |Name of Country: |
|Chakaria |Multi Centre Trial |
|Abhoynagar |(Name other countries involved): |
|Type of Study (Check all that apply): |
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|Case Control Study |
|Community-based Trial/Intervention |
|Program Project (Umbrella) |
|Secondary Data Analysis |
|Clinical Trial (Hospital/Clinic) |
|Family Follow-up Study |
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|Cross Sectional Survey |
|Longitudinal Study (cohort or follow-up) |
|Record Review |
|Prophylactic Trial |
|Surveillance/Monitoring |
|Others: |
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|NOTE: Does the study meet the definition of clinical studies/trials given by the International Committee of Medical Journal |
|Editors (ICMJE)? Yes No |
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|Please note that the ICMJE defined clinical trial as “Any research project that prospectively assigns human subjects to intervention and comparison |
|groups to study the cause-and-effect relationship between a medical intervention and a health outcome”. |
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|If YES, after approval of the ERC, the PI should complete and send the relevant form to provide required information about the research protocol to the |
|Committee Coordination Secretariat for registration of the study into websites, preferably at the . It may please be noted that |
|the PI would require to provide subsequent updates of the research protocol for updating protocol information in the website. |
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|Targeted Population (Check all that apply): | |
| |Expatriates |
|No ethnic selection (Bangladeshi) |Immigrants |
|Bangalee |Refugee |
|Tribal group | |
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|Consent Process (Check all that apply): | |
| |Bengali Language |
|Written |English Language |
|Oral | |
|None | |
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|Proposed Sample Size: |
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|Sub-group (Name of subgroup (e.g. Men, Women) and Number |
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|Name |
|Number |
|Name |
|Number |
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|(1) Index case patients (2009) |
|200 |
|(3)Index case patients (2010) |
|400 |
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|(2) Household contacts (2009) |
|2000 |
|(4) Household Contacts (2010) |
|4000 |
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|Total sample size: 6600 |
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|a) Will the specimen be stored for future use? Yes No |
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|b) If yes, how long the specimens be preserved? _20 years. |
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|c) Will consent be obtained from study participants Yes No NA |
|for the specimen be stored for future, for unrelated use |
|without further taking consent? |
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|d) What types of tests will be carried out with the preserved samples? Tests will be for identification of respiratory illness other than influenza |
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|e) Will the samples be shipped to other country(ies)? Yes No NA |
|f) If yes, name of institution(s) and country(ies): ______ surplus aliquots may be shipped to the CDC in Atlanta, GA, USA for confirmation of |
|unsubtypable samples and for random quality control.___ |
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|g) Will the surplus/unused specimen be returned to the Centre? Yes No NA |
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|h) Who will be the custodian of the specimen at the Centre |
|and when shipped outside of the country(ies)?: __Mustafizur Rahman , PhD, ICDD,B Influenza Laboratory__ |
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|i) Who will be the owner(s) of the samples? : _______________ICDDR,B |
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|j) Has a MoU been made for the protocol covering the |
|specimen collection, storage, use and ownership? Yes No NA |
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|k) If yes, please attach a copy. |
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|Determination of Risk: Does the Research Involve (Check all that apply): |
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|Human exposure to radioactive agents? |
|Fetal tissue or abortus? |
|Investigational new device? |
|(specify:) |
|Existing data available from Co-investigator |
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|Human exposure to infectious agents? |
|Investigational new drug |
|Existing data available via public archives/sources |
|Pathological or diagnostic clinical specimen only |
|Observation of public behaviour |
|New treatment regime |
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|Yes |
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|No |
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|Is the information recorded in such a manner that study participants can be identified from information provided directly or through identifiers linked |
|to the study participants? |
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|Yes |
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|No |
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|Does the research deal with sensitive aspects of the study participants’ behaviour; sexual behaviour, alcohol use or illegal conduct such as drug use? |
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|Could the information recorded about the individual if it became known outside of the research: |
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|Yes |
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|No |
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|Place the study participants at risk of criminal or civil liability? |
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|Yes |
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|No |
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|Damage the study participants’ financial standing, reputation or employability, social rejection, lead to stigma, divorce etc.? |
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|Do you consider this research (Check one): |
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|Greater than minimal risk No more than minimal risk |
|Only part of the diagnostic test |
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|Minimal Risk is "a risk where the probability and magnitude of harm or discomfort anticipated in the proposed research are not greater in and of |
|themselves than those ordinarily encountered in daily life or during the performance of routine physical, psychological examinations or tests. For |
|example, risk of drawing a small amount of blood from a healthy individual for research purposes is no greater than the risk of doing so as a part of |
|routine physical examination". |
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|Yes/ No |
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|Is the proposal funded? |
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|If yes, sponsor Name: (1) Centers for Disease Control and Prevention (CDC) |
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|(2) |
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|Yes/No |
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|Is the proposal being submitted for funding? |
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|If yes, name of funding agency: (1) |
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|(2) |
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|Do any of the participating investigators and/or member(s) of their immediate families have an equity relationship (e.g. stockholder) with the sponsor |
|of the project or manufacturer and/or owner of the test product or device to be studied or serve as a consultant to any of the above? |
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|IF YES, a written statement of disclosure to be submitted to the Centre’s Executive Director. |
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|Dates of Proposed Period of Support Cost Required for the Budget Period ($) |
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|Years |
|Direct Cost |
|Indirect Cost |
|Total Cost |
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|Year-1 |
|127,040 |
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|40,125 |
|166,573 |
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|Year-2 |
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|0[pic]0 |
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|Year-3 |
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|0[pic]0 |
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|Year-4 |
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|0[pic]0 |
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|Year-5 |
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|0[pic]0 |
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|Total |
|127,040 |
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|40,125 |
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|167,165 |
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|(Day, Month, Year - DD/MM/YY) |
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|Beginning Date : 01 May 2009 |
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|End Date : 31 Decmeber 2010 |
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|Certification by the Principal Investigator |
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|I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent |
|statements or claims may subject me to criminal, civil, or administrative penalties. I agree to accept the responsibility for the scientific conduct of |
|the project and to provide the required progress reports including updating protocol information in the SUCHONA (Form # 2) if a grant is awarded as a |
|result of this application. |
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|___________ ____________ |
|Signature of PI |
|Date |
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|Approval of the Project by the Division Director of the Applicant |
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|The above-mentioned project has been discussed and reviewed at the Division level as well by the external reviewers. The protocol has been revised |
|according to the reviewers’ comments and is approved. |
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|Name of the Division Director |
|Signature |
|Date of Approval |
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RRC APPLICATION FORM 1
Project Summary 9
Description of the Research Project 11
Hypothesis to be Tested: 11
Specific Aims: 12
Background of the Project including Preliminary Observations 12
Research Design and Methods 15
Measures of interest 25
Laboratory methods 28
Sample Size Calculation and Outcome Variable(s) 31
Data Safety Monitoring Plan (DSMP) 34
Data Analysis 35
Ethical Assurance for Protection of Human Rights 38
Use of Animals 39
Literature Cited 40
Dissemination and Use of Findings 42
Collaborative Arrangements 42
Biography of the Investigators 42
Budget Justifications 66
Personnel 66
Other Support 67
Appendix 1: Figure and Details about Bari 68
Appendix 2: Adult Consent Form: Specimen Collection 69
Appendix 3: Parent or Guardian Consent Form: Specimen Collection 72
Appendix 4: Child Assent Form: Specimen Collection 75
Appendix 5: Consent Form: Study Enrollment, Household/Bari 77
Appendix 6: Bari Eligibility Form 91
Appendix 7: Bari Drawing Form 93
Appendix 8: Household Contact Enumeration Form 95
Appendix 8b: Enrollment Day Sick List for all Bari members 96
Appendix 9: Household Level Questionnaire/Observation Form 97
Appendix 10: Illness Tracking Form (for all ages) Version 18.5.10 135
Appendix 18: BISTIS Follow Up Survey Form 158
Appendix 19: Follow Up Soap Tracking Form 177
Appendix 21a: Follow Up Phone Call Illness Tracking Form: Ages ≥ 5 Years Old, Page 1 180
Appendix 21a: Follow Up Phone Call Illness Tracking Form: Ages ≥ 5 Years Old, Page 2 181
Appendix 22: Responses to the comments from the external reviewers 202
Check here if appendix is included
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|Project Summary |
|Describe in concise terms, the hypothesis, objectives, and the relevant background of the project. Also describe concisely the experimental design |
|and research methods for achieving the objectives. This description will serve as a succinct and precise and accurate description of the proposed |
|research is required. This summary must be understandable and interpretable when removed from the main application. |
|Principal Investigator(s): Dr. Eduardo Azizz-Baumgartner |
|Research Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of |
|Secondary Transmission of Influenza Study (BISTIS) |
|Total Budget US$: 166,573 Beginning Date : 1 May 2009 Ending Date: 31 December 2010 |
|The next influenza pandemic is expected to spread rapidly in resource-poor settings. Influenza viruses spread from human-to-human via large |
|respiratory droplets. Transmission via large-particle respiratory droplets is believed to be mediated by close contact between infected and |
|susceptible persons or contact with droplet-contaminated fomites. Close contact between infected and susceptible persons may consist of skin-to-skin|
|contact (e.g., via hands) or inhalation of respiratory droplets (e.g., due to talking, coughing, or sneezing by the infected person). Airborne |
|transmission, which is expected to result in transmission over long distances (>1 meter) and which would be mediated by ventilation, is believed to |
|be uncommon. Therefore, the greatest risk of transmission from personal contact comes from those people who are closest to an index case, such as |
|contacts living in the same household. There are, to date, no published estimates of the secondary attack ratio of influenza among household |
|contacts of index case-patients in low-income countries. Moreover, we do not have data on the risk factors for secondary transmission of influenza |
|from index case-patients to their household contacts. There is some data for the benefits of promoting handwashing with soap on the risk of |
|all-cause acute respiratory illness among children < 15 years old in a resource-poor setting in Pakistan. But, we do not have evidence that |
|promoting handwashing with soap will acutely reduce the risk of secondary transmission. Therefore, we propose to conduct a study in rural Bangladesh|
|to assess the following: |
|The secondary attack ratio of influenza among household contacts of an index case-patient with influenza |
|The risk factors for secondary transmission of influenza from an index case-patient to household contacts |
|The impact of promoting handwashing with soap on the risk of secondary transmission of influenza from an index case-patient to household contacts |
|The impact of a handwashing promotion intervention on handwashing behavior at 5-6 months following the intervention. |
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|To complete our study objectives, we will conduct a randomized controlled trial in the Kishoregonj area of Bangladesh, building on ongoing influenza |
|surveillance at the Jahurul Islam Medical College Hospital (JIMCH). We will identify eligible index case-patients with influenza at the JIMCH, two |
|local Upazilla Health Complex (UHC) clinics, pharmacies and other local health care providers. Index case-patients will be identified as having |
|influenza using a rapid diagnostic test for influenza (QuickVue®). Our study workers will visit the bari, obtain informed consent, and collect |
|baseline information about the bari, including information on crowding, ventilation of the cooking space, and smoking status of bari residents. We |
|will then assign baris to the intervention or control arm at random using a block randomization strategy. The intervention will consist of promotion|
|of handwashing with soap and the provision of soap and a water vessel to facilitate handwashing; the intervention will be based on the Social |
|Cognitive Theory. We will then follow up intervention and control baris for a total of 10 days following the resolution of the index case-patient’s |
|illness, in order to track illness in each bari resident. At the conclusion of the illness tracking, control baris will be provided bars of soap. At|
|a future time, the control baris will be provided a water vessel, and the same handwashing promotion session provided to intervention baris. We will |
|follow-up with all enrolled baris 5-6 months after illness tracking was completed to assess handwashing behavior. We will use objective measures of |
|handwashing behavior, and will also assess knowledge about influenza. |
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|KEY PERSONNEL (List names of all investigators including PI and their respective specialties) |
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|Name |
|Professional Discipline |
|/ Specialty |
|Role in the Project |
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|Eduardo Azizz-Baumgartner |
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|ICDDR,B |
|Co-Principal Investigator |
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|Pavani K. Ram |
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|University at Buffalo |
|Co-Principal Investigator |
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|Tasnim Azim |
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|ICDDR,B |
|Co-Investigator |
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|Joseph Bresee |
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|CDC |
|Co-Investigator |
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|W. Abdullah Brooks |
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|ICDDR,B |
|Co-Investigator |
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|Margaret DiVita |
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|University at Buffalo |
|Student Investigator |
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|Alicia Fry |
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|CDC |
|Co-Investigator |
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|Stephen Luby |
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|ICDDR,B |
|Co-Investigator |
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|Mustafizur Rahman |
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|ICDDR,B |
|Co-Investigator |
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|Rashid Uz Zaman |
|ICDDR,B |
|Co-Investigator |
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Description of the Research Project
Hypothesis to be Tested:
Concisely list in order, the hypothesis to be tested and the Specific Aims of the proposed study. Provide the scientific basis of the hypothesis, critically examining the observations leading to the formulation of the hypothesis.
There is secondary transmission of influenza from index case-patients to household contacts in a rural setting.
Promotion of handwashing with soap will reduce secondary transmission of influenza from index cases to household contacts.
Risk factors for intrahousehold transmission of influenza in a rural setting include young age of index case or of household contact, active or passive smoking, crowding, and poor ventilation.
Exposure to an intensive handwashing education intervention will result in sustained improvement in handwashing behavior change.
Exposure to an intensive handwashing education intervention will result in a reduced risk of respiratory infections, diarrhea, and influenza.
Specific Aims:
Describe the specific aims of the proposed study. State the specific parameters, biological functions/ rates/ processes that will be assessed by specific methods.
To measure the secondary attack ratio of influenza among household contacts of index cases with influenza, in a rural setting in Bangladesh
To test the efficacy of an intervention promoting handwashing with soap for prevention of intrahousehold transmission of influenza virus
To identify risk factors for intrahousehold transmission of influenza in a rural setting in Bangladesh
To compare handwashing behavior among households who were exposed to the intervention promoting hanwashing with soap to handwashing behavior among households who were not exposed to the intervention 5-6 months after enrollment
To measure the longitudinal prevalence of respiratory infections, diarrhea, and influenza among intervention and control households 5-6 months after enrollment.
Background of the Project including Preliminary Observations
Describe the relevant background of the proposed study. Discuss the previous related works on the subject by citing specific references. Describe logically how the present hypothesis is supported by the relevant background observations including any preliminary results that may be available. Critically analyze available knowledge in the field of the proposed study and discuss the questions and gaps in the knowledge that need to be fulfilled to achieve the proposed goals. Provide scientific validity of the hypothesis on the basis of background information. If there is no sufficient information on the subject, indicate the need to develop new knowledge. Also include the significance and rationale of the proposed work by specifically discussing how these accomplishments will bring benefit to human health in relation to biomedical, social, and environmental perspectives.
The emergence of the highly pathogenic avian influenza A (H5N1) among humans throughout South and Southeast Asia and Eastern Europe[1] , and the potential for a new global pandemic of H5N1 or another influenza subtype, highlight the immediate need to identify risk factors for influenza transmission in low-income settings and to assess the efficacy of interventions to reduce the transmission of influenza viruses in these settings.
Influenza viruses spread from human-to-human via large respiratory droplets.[2] Transmission via large-particle respiratory droplets is believed to be mediated by close contact between infected and susceptible persons or contact with droplet-contaminated fomites.[2-3] Close contact between infected and susceptible persons may consist of skin-to-skin contact (e.g., via hands) or inhalation of respiratory droplets (e.g., due to talking, coughing, or sneezing by the infected person).[4] Airborne transmission, which is expected to result in transmission over long distances (>1 meter) and which would be mediated by ventilation, is believed to be uncommon.[4] Therefore, the greatest risk of transmission from personal contact comes from those people who are closest to an index case, such as contacts living in the same household.
The incubation period of the influenza virus is short, lasting typically 1 to 3 days. The infectious period for adults may begin 1 day prior to the onset of symptoms, and last until 5 days after symptoms begin. Children can be infectious for up to 7 days after symptom onset. The epidemiology of influenza has been well documented and understood in industrialized countries, but the data on influenza in developing countries is minimal. Globally, influenza epidemics occur annually, with clinical attack rates ranging from 10 to 20 percent in the general population, and more than 50 percent in closed populations, such as schools. Hospitalizations and deaths typically occur in high risk groups such as the elderly, very young, and the immuno-compromised. The death toll associated with annual epidemics of influenza is estimated to reach nearly 1 million people per year[5].
In a low-income setting such as Bangladesh, 16% of children aged less than 13 years with fever and cough (and who tested negative for dengue infection) were found to have influenza type A or B infection.[6] The first recognized human case of A(H5N1) influenza in Bangladesh occurred in 2008 in a child in Kamalapur, a densely populated urban slum in Dhaka, the capital city.[7] In order to develop rational prevention strategies, it is essential that we identify the relationship between demographic, behavioral, and environmental factors and influenza transmission among contacts of infected persons in low-income settings. Poor hand hygiene[8], crowding[9], and tobacco use[10] are commonplace in Bangladesh and thought to contribute to respiratory illness and outbreaks of respiratory illness (refs).[11] Only 14% of primary caregivers of young children in rural Bangladesh were observed to wash hands with soap before preparing or serving food and none washed hands before eating.[12] In another study with a substantially larger sample size, the proportion of primary caregivers observed to wash hands with soap was less than 1 percent.[13] In rural Mirzapur, crowding was shown to be a risk factor for viral pneumonia among children < 24 months of age.[9] Nationwide, in Bangladesh, 40% of adult males and 21% of adult females were estimated to be tobacco users in 2001.[14] Passive exposure to tobacco smoke has been implicated as a risk factor for respiratory illness among children.[10-11, 15] We do not fully understand the relevance of these factors for transmission of Influenza virus from ill persons to their household contacts.
In high-income countries, annual vaccination of high risk groups is the principal measure of prevention and control of influenza illness.[2] These measures are not available at scale in resource-poor settings, where the next influenza pandemic is expected to have devastating consequences. In such settings, therefore, it is imperative to assess the efficacy of non-pharmaceutical interventions to prevent the spread of influenza. Indeed, non-pharmaceutical interventions such as handwashing with soap are already recommended for prevention of influenza transmission (). However, there is no published empirical evidence for the efficacy or effectiveness of handwashing with soap for prevention of influenza transmission in resource-poor settings. A recent meta-analysis done by Aiello et al found that most studies assessing the effectiveness of hand washing interventions upon infectious disease treated any respiratory illness as the outcome, not specifically influenza virus, and that the majority of the studies found took place in high-income settings (67%).[16] Moreover, a systematic review of the literature done by Jefferson et al shows that the majority of trials assessing the impact of hand washing on respiratory illness were done in day care or hospital settings.[8] Since the risk of transmission is likely high among household contacts of ill persons in low-income settings, it is crucial that such interventions are tested within households.
Given that much influenza transmission occurs among close contacts, the critical role that non-vaccine interventions will play in prevention of pandemic influenza transmission in resource-poor settings, and the high likelihood that the next influenza pandemic will greatly impact such a setting, we propose to conduct a multi-pronged study in Bangladesh.
Our objectives are:
To measure the secondary attack ratio of influenza among household contacts of influenza-infected persons in a rural setting in Bangladesh
To test the efficacy of a handwashing promotion intervention for prevention of intrahousehold transmission of influenza virus in a rural setting in Bangladesh
To investigate risk factors for secondary transmission of influenza from index case-patients to household contacts
Since Bangladesh has high rates of influenza illness and vaccination of this population is virtually non-existent, it represents an ideal setting for the proposed study. While several studies regarding handwashing and respiratory illness, including influenza, have been and will be carried out in urban slum areas of Dhaka, there is little information on the role of handwashing and other risk factors for influenza transmission within households in rural areas. About ¾ of the Bangladeshi population lives in rural areas[17] and contact with poultry, a risk factor for avian influenza, is substantially more common in rural communities. For this reason, and because the Jahurul Islam Medical College Hospital is a high-functioning participant in an ongoing human influenza surveillance project, we have chosen this site.
We also propose to complete a follow-up study of all households enrolled in the original study. The intervention given is particularly intensive in nature because we seek to establish whether maximal improvement in handwashing behavior will prevent secondary transmission of influenza. Luby and colleague have undertaken intensive handwashing promotion in their studies in Karachi, Pakistan on the efficacy of handwashing for the presevention of diarrhea and pneumonia. Despite weekly visits to intervention households to promote handwashing and to provide soap over an entire year, Luby et al. found little sustained behavior change among these households [18]. Moreover, there was no difference in the disease risk among children in intervention households, compared to those in control households who had not received the intervention. The intervention proposed for this study is even more intensive than that used in the Karachi studies because it seeks to reinforce benefits, overcome barriers, and motivate group-level behavior change. This proof of concept study not only hopes to find a difference in the rate of secondary transmission of influenza during the intervention, but also hopes to yield sustainable improvements in handwashing behavior change. Therefore, we propose to complete a follow-up study to answer the following questions:
Does exposure to the intervention in the primary intervention study result in sustained handwashing behavior change?
Does exposure to the intervention in the primary intervention study result in a reduced risk of respiratory infections, diarrhea, and influenza in intervention households compared to control households.?
The proposed study will hereafter be referred to as the Bangladesh Interruption of Secondary Transmission of Influenza study (BISTIS).
Research Design and Methods
Describe in detail the methods and procedures that will be used to accomplish the objectives and specific aims of the project. Discuss the alternative methods that are available and justify the use of the method proposed in the study. Justify the scientific validity of the methodological approach (biomedical, social, or environmental) as an investigation tool to achieve the specific aims. Discuss the limitations and difficulties of the proposed procedures and sufficiently justify the use of them. Discuss the ethical issues related to biomedical and social research for employing special procedures, such as invasive procedures in sick children, use of isotopes or any other hazardous materials, or social questionnaires relating to individual privacy. Point out safety procedures to be observed for protection of individuals during any situations or materials that may be injurious to human health. The methodology section should be sufficiently descriptive to allow the reviewers to make valid and unambiguous assessment of the project.
BISTIS builds on hospital-based surveillance for Influenza virus infection, which is ongoing in hospitals around Bangladesh, as part of the Hospital-based Influenza Surveillance (HBIS) and Surveillance for the Epidemiology of Influenza in Bangladesh (SEIB) projects. We intend to recruit patients identified at the Jahurul Islam Medical College Hospital in Kishoregonj, Bangladesh, where both HBIS and SEIB are in place. In this hospital 80% of all the patients who present with influenza-like illness (ILI) to the outpatient departments of Medicine and Pediatrics are from three upazillas of Kishorgonj district: Bajitpur, Kuliar char and Kotiadi. The distances of these three upazillas are within 30 minutes travel time from Jahurul Islam Medical College Hospital (one way) and hence these upazillas will serve as the primary catchment areas for BISTIS. The table below illustrates the number of ILI cases identified through HBIS and SEIB study at Jahurul Islam Medical College Hospital in 2008 and also the number and proportion among them who were tested PCR positive for influenza virus.
[pic]
N.B. most influenza-positive specimens were collected between May and September in 2007 and 2008
We will also enroll patients who present to two local upazilla health complexes (UHCs), one in Bajitpur and one it Kuliar Char. These local health complexes see numerous patients a day from the rural areas surrounding the clinic. Patients who present to these clinics are more likely to have symptom onset within 24 hours of presentation then those patients who seek care at JIMCH, since patients may only want to go to the hospital if their illness has been severe and prolonged over several days. There has been published evidence that interventions on handwashing practices will only prevent influenza transmission in a household setting if the intervention is delivered within 36 hours of symptom onset [19]; therefore, the UHC sites are appropriate for enrollment of patients for BISTIS in addition to enrollment at JIMCH.
We will also enroll patients who present to pharmacies and other local health care providers in Bajitpur and Kuliarchar. During the enrollment in the early 2010 season, we have found that many individuals seeking care at the UHCs are waiting longer than 24 hours after symptom onset to visit the UHC. We hypothesize that individuals with symptom onset within 24 hours may seek early treatment at local pharmacies and other local health care providers, and only then visit the UHCs or JIMCH should their symptoms persist. By the time many individuals seek further treatment, there may be secondary cases within the bari. With secondary transmission occurring at the bari level prior to the individual seeking care at our enrollment sites, this greatly weakens our ability to determine whether our intervention does in fact prevent influenza transmission within the bari. Therefore, we propose to enroll index case-patients at local pharmacies and other local health care providers, in addition to the UHCs and JIMCH.
The medical officers will identify pharmacies and other local health care providers willing to allow placement of one of our FRAs for several hours on each working day. We will place one FRA at each participating site. The pharmacist or health care provider will identify individuals with fever, and will refer that person to our FRA. The FRA will then complete the Hospital Check List Form (Appedix 13) to determine the eligibitlity of the individual. When the FRA finds a person who meets the eligibility criteria, he/she will contact an MO by phone to confirm that the person does in fact meet eligibility. Once the MO confirms the eligibility, the FRA will obtain informed consent for a sample collection. If the person consents, the FRA should then contact the MT or MO to let them know that the participant requires specimen collection. The MT or MO can either meet the FRA and participant at the pharmacy for the specimen collection, or the FRA can travel to the bari with the participant and the MT or MO can meet them there, which ever is more convenient. The sample collection for the participant enrolled at the pharmacy or other local health care provider should take place no later than 24 hours after enrollment, although a concerted effort should be made to collect the sample the same day as enrollment.
Specific Aim 1: To measure the secondary attack ratio (SAR) of influenza viruses among household contacts of index cases with influenza, in a rural setting in Bangladesh
Methods for Specific Aim 1
In the ongoing SEIB and HBIS projects, patients at Jahurul Islam Medical College Hospital with influenza-like illness (ILI) or severe acute respiratory illness (SARI) and who are seen as outpatients are requested to provide nasal and oropharyngeal swab specimens for testing for influenza virus. The sample collections occur on 6 days per month in the outpatient population.
ILI and SARI are currently defined as follows:
Influenza-like illness (ILI): any patient presenting with history of fever and either cough or sore throat within the previous 7 days
Severe acute respiratory illness (SARI):
Patients > 5 years of age: hospitalized patient with acute lower respiratory tract illness consisting of fever
And cough or sore throat
And shortness of breath or difficulty breathing
Patients < 5 years of age: definition of pneumonia or severe pneumonia as per the Integrated Management of childhood Illness guidelines[20]
For BISTIS, we plan to daily identify patients meeting the following age-specific case definitions, and to request them to provide specimens (with the exception of Tuesdays when the hospital is closed) for the duration of the study.
The case definition for index case-patients is:
Persons, any age, with acute fever onset within 7 days preceding presentation to either JIMCH, the UHCs, the pharmacies, or other local health care providers.
Additional inclusion criteria for the proposed study are:
Return to home within 24 hours of presentation to Jahurul Islam Medical College Hospital, the UHCs, the pharmacies, or other local health care providers; i.e., the index case cannot be admitted at Jahurul Islam Medical College Hospital. If admitted, the patient would not be eligible for inclusion in this study.
At least two persons (in addition to the index case-patient) who intend to reside in the bari during the subsequent 20 days.
Residence within 2 hours travel time (one-way) from the Jahurul Islam Medical College Hospital or the UHCs
Patients who meet the case definition and additional inclusion criteria will hereafter be referred to as index case-patients.
In rural Bangladesh, homes are typically clustered into baris, with several homes in each bari (appendix 1 – figure and details about baris). Typically, related individuals, with extended or joint family kinships, live in these homes and there is one head of the bari (usually the most elderly man). There is substantial contact between residents of different homes within a bari, with shared cooking spaces, play areas for children, toilets, and courtyards. Thus, most or all bari members are at risk for secondary transmission of influenza, irrespective of which specific home is occupied by an index case. For the purposes of this study, therefore, the household refers to the entire bari in which the index case-patient’s home sits. Hereafter, “household contact” refers to any member residing in the bari, apart from the index case-patient.
Within 4 hours of presentation to the Jahurul Islam Medical College Hospital, the UHCs, the pharmacies, or other local health care providers, the medical officer will approach patients who meet inclusion criteria in order to describe the study. The index case-patient or his/her guardian in the case of a child < 18 years old will be requested to provide informed consent for specimen collection for rapid testing for influenza (appendix 2 and 3 –consent for specimen collection and parental consent for specimen collection). Children between 7 and 17 years old will be requested to provide informed assent for specimen collection (appendix 4 – assent for specimen collection).
Specimen collection and processing
A trained study physician will procure a nasal swabfrom consenting index case-patients meeting the inclusion criteria above using a standardized method. This specimen will be used for a rapid antigen detection test (QuickVue® Influenza A + B). After the results of the QuickVue test are known, for patients ages 5 years and older a second nasal swab and an oropharyngeal swab will be take and both will be placed into a single tube containing viral transport media (VTM). The VTM will be kept at 4°C. All VTM will be transported to the ICDDR,B virology laboratory in Dhaka on a weekly basis. At the ICDDR,B virology laboratory, RT-PCR testing for Influenza A (H1N1), Influenza A ( H3N2), Novel Influenza A (H1N1) and Influenza B will be carried out. If Influenza A H1N1 and , novel H1N1, and A H3N2 are both all negative, RT-PCR testing for Influenza A H5N1 will be performed. The QuickVue® test materialswill be discarded using appropriate infection control procedures.
Enumeration of bari contacts and questionnaire administration
For all index case patients who meet the age-specific case defintions we will request that a field research assistant (FRA) accompany the index case-patient to the household. Once at the bari, the FRA will verify whether the bari meets the following inclusion criteria using the Bari Eligibility Form (Appendix 6):
Inclusion criteria for baris of index case-patients are:
At least two persons (in addition to the index case-patient) who intend to reside in the bari during the subsequent 20 days. Residence in the bari refers to sleeping in the bari at night, even if the individual works outside the bari during the day.
Written informed consent for the following study components from the head of bari on behalf of all bari residents (Appendix 5 – household consent) for each bari enrolled in the study
Questionnaire administration
Rapid observations of the household
Illness tracking
Random assignment to intervention or control group
The FRA will draw the bari (appendix 7: Drawing of Bari Form), recording the following items in the bari: housing structures, water source, toilet facilities, cooking areas, handwashing station (present before intervention), intervention handwashing station (to be filled in for intervention households only), the entrance to the bari, the entrance of the housing structures, and households.
The FRA will enumerate all eligible bari contacts (appendix 8 – enumeration sheet) and carry out assessments of ventilation, crowding, indoor air pollution, smoking, and socioeconomic status (appendix 9– household questionnaire/ observations . These measures are described in more detail below. The questionnaire will be administered to each household within the index case-patient’s bari. For the purposes of our study, we will define a “household” as individuals who share the same cooking pot. Some questions will be specific to each household or housing structure within the bari, in which case we will pose those questions to the male or female head of that particular household and structure. Housing structure is defined as where individuals sleep.
Illness tracking among bari contacts
Illness tracking will be carried out on each day for 10 days until after resolution of the index case-patient’s symptoms. Resolution will be defined as the lack of fever, cough, and sore throat for two consectutive days during the FRA’s daily illness tracking visit. Thus, if the index case-patient’s illness resolves on day 4 after enrollment, illness tracking will continue until day 14 after enrollment. The FRA will visit the patient’s home and record information regarding the presence or absence of ILI and SARI symptoms in each household contact using an individual illness tracking form (appendix 10– illness tracking form).
The case definitions for household contacts are:
Any bari resident with fever during the follow up visits of the index cases by the FRAs.
If any household contact meets the case definition, that person will be eligible for testing for influenza by the medical officer or technologist. If any household contact reports the following danger signs, the FRA will refer him/her immediately to the Jahurul Islam Medical College Hospital:
Persons > 5 years old: Cyanosis, severe respiratory distress, convulsions, altered mental status
Persons < 5 years old: Chest in-drawing, lethargy, cyanosis, inability to drink, convulsions
The FRA will pay for transport of the ill household contact and one or two accompanying family members to Jahurul Islam Medical College Hospital. S/he will provide a card indicating the ill household contact’s participation in BISTIS, so that when s/he arrives at the hospital, the BISTIS study physician will be contacted. Once the patient is deemed clinically stable by physicians at JIMCH, the BISTIS study physician will verify that the ill household contact meets the age-specific case definition and will request him/her to provide written informed consent for specimen collection (appendix 2 – specimen collection from household contact for adult > 18 years old). If the ill household contact is a child < 18 years old, informed consent will be obtained from the parent or guardian (appendix 3 – specimen collection from household contact for child < 18 years old). Children between 7 and 17 years old will be requested to provide informed assent for specimen collection (appendix 4 – assent for specimen collection). The medical technologists will collect information on the type of visit (secondary or follow up) and the date and time of the specimen collection on the specimen collection form (Appendix 11: Secondary/Follow Up Specimen Collection Form). We will store samples for 20 year for future testing of respiratory illnesses other than influenza; consent for specimen storage will be included in the specimen collection consent/assent form. If informed consent for specimen collection is provided, the study physician will collect nasal and oropharyngeal swabs from the ill household contact and place them in a single VTM vial. As with other specimens collected under BISTIS at the Jahurul Islam Hospital, the VTM vial will be kept at 4°C. Of course, it is the choice of the patient or guardian (in the case of an ill household contact < 18 years old) to decide whether or not to comply with the FRA’s recommendation to go to Jahurul Islam Medical College Hospital. In the event that the ill individual does not comply with the recommendation, the FRA will notify the BISTIS study physician. The physician will visit the bari within 24 hours to assess the ill household contact and provide further recommendations regarding treatment.
If a household contact meets the case definition and does NOT have any danger signs, the FRA will contact the MO to travel to the bari to obtain written informed consent for specimen collection (appendix 2– Adult Consent Form: Specimen Collection, Appendix 3—Parental Guardian Consent Form: Specimen Collection, Appendix 4—Child Assent Form: Specimen Collection). The medical officer, who will visit the home no later than the following day in order to collect nasal and oropharyngeal swabs from the ill household contact. She will immediately place both swabs into VTM, which will then be placed into a cool box, containing ice and a thermometer to ensure temperatures < 40C.
All specimens collected in the field will be placed in a liquid nitrogen dewer and will be transported to the ICDDR,B laboratory within two weeks of sample collection. At the ICDDR,B virology laboratory, all specimens for household contacts in baris where the index case patient tested QuickVue positive will be tested using RT-PCR for Influenza A (H1N1), A (H3N2), novel Influenza A (H1N1) and Influenza B (and A (H5N1) if appropriate). For household contacts of index case patients who tested QuickVue negative, the specimens will only be rt-PCR tested for influenza if the index case’s rt-PCR test is positive for influenza.
Illness tracking among household contacts will continue in each household until the 10th full day following the resolution of the index case-patient’s symptoms, irrespective of whether any household contact develops illness or not.
Specific Aim 2: To test the efficacy of a handwashing promotion intervention for prevention of intrahousehold transmission of influenza virus
Methods for Specific Aim 2
To address this specific aim, we will conduct a randomized controlled trial. Households of index case-patients with influenza-like illness who are not admitted at Jahurul Islam Medical College Hospital or the UHCs will be randomized to the intervention group or the routine practices group. The two groups will be defined as:
Intervention Households: intensive promotion of handwashing with soap, and provision of facilitating tools, to the index-case-patient and all available household contacts
Routine practices Households: continuation of the household’s usual handwashing and respiratory hygiene practices
Randomization
We will carry out block randomization of households of index case-patients to ensure random and even assignment to the intervention group or the routine practices group. Using a block size of four, the US-based co-Principal Investigator (PKR) will generate a list of random assignments to the routine practice or intervention groups. There will be two randomization sheets, one for the index case patients who test QuickVue positive and one for the index case patient’s who test QuickVue negative, to ensure equal assignment of the intervention among households with known positive influenza cases. The lists will be shared with the ICDDR,B PI and the FROs based at JIMCH. The FRO will consult the assignment list in order to determine whether the next enrolled household should be allocated to the intervention group or the routine practices group.
Delivery of the intervention
After the head of the bari has signed the informed consent for bari enrollment in the study, the FRA will telephone the FRO and tell the FRO that the bari has been enrolled. The FRO will consult the appropriate randomization sheet, and, if the bari is assigned to the intervention group, the FRO will assign an FIS to visit the household later in the day, after the FRA has finished with data collection.
For promotion of handwashing with soap to intervention households, the FIS will be trained to carry out a structured intervention that will follow constructs of Social Cognitive Theory (SCT)[21]. SCT addresses the reciprocal interaction between individuals, their environment, and health behaviors. Given that intervention will occur at the bari level, group-mediated constructs such as observational learning and reinforcements are highly relevant. We have included below a table of the major constructs of SCT, their definitions, and application of the constructs within this intervention.
In addition, the FIS will work with the household to identify the most convenient place to wash hands with soap and water. If no water container, or sink is present, the FIS will provide a water container that has a spout for running water
FISs will visit the intervention households on a daily basis for 10 days after the resolution of the index case-patient’s illness in order to encourage handwashing with soap at the recommended times. The FIS and FRA will coordinate their visits to the household so that they do not arrive at the same time. This will decrease the possibility of observer bias by the FRA should s/he see the intervention being implemented in the household while s/he is tracking illness symptoms. S/he will also note daily whether soap and water are available at the convenient handwashing station and, if not, s/he will again take necessary steps to assist the family with complying with a fully stocked handwashing station. The FIS will track both compliance with maintenance of a fully stocked handwashing station and the provision of additional soap or a tippy tap to the home. (Appendix 12 – facilitating tools tracking).
Routine practices households will also be exposed to the intervention, but only upon completion of the study. An FIS will visit the routine practices household around 6 months after the completion of the study in order to encourage handwashing with soap at the recommended times, andto provide a water container as needed.
Blinding
Due to the physical nature of the intervention and no feasible placebo control, we will not be able to blind participants or FRAs during illness tracking. However, FRAs will be blinded to the intervention assignment until after the first day’s data collection. We accept this limitation in order to achieve the most intensive handwashing intervention possible.
Detection of outcome of interest
As noted above, under Specific Aim 1, an FRA will visit the home of the index case-patient daily for 10 days after the resolution of the index case-patient’s symptoms in order to record age-specific case defining symptoms. When a household contact meets the age-specific case definition, nasal and oropharyngeal swabs will be collected for RT-PCR testing for Influenza A and Influenza B viruses at ICDDR,B.
Specific aim 3: To identify risk factors, other than handwashing with soap, for intrahousehold transmission of influenza in a rural setting in Bangladesh
Methods for Specific Aim 3
To address Specific Aim 3, we will conduct a nested cohort study to assess risk factors for intrahousehold transmission of influenza viruses. Here, the cohort under investigation is the routine practices group, as defined under Specific Aim 2. All data required to address this Specific Aim 3 will have been collected as part of the data collection described above under Specific Aim 1.
A case will be defined as: RT-PCR confirmed Influenza virus infection (A or B) in a household contact of an RT-PCR confirmed Influenza virus infection (A or B) index case-patient during 10 days of follow-up after resolution of the index case-patient’s symptoms
Specific aim 4: To assess whether exposure to the BISTIS intervention results in sustained improvements in handwashing behavior.
Methods for Specific Aim 4
To address Specific Aim 4, we will visit each bari that was enrolled in the intervention study 4 - 7 months after illness tracking is complete. Baris were told at the time of enrollment into the primary BISTIS study that field workers would be visiting again in several months for further data collection. An FRA will visit the bari and explain the objectives and methods of the follow-up study and request written voluntary informed consent (Appendix 16: BISTIS Follow Up Study Enrollment Consent Form, Household/Bari).
After consent is taken, at the first visit, the FRA will measure handwashing behavior at the bari. We will complete a structured observation of the bari’s common handwashing behaviors. This observation will last for one and a half hours. We will record information on handwashing opportunities, such as after defecation or before preparing meals, and hand washing behaviors. Handwashing behavior will be also measured by the following methods (Appendix 18: BISTIS Follow Up Survey Form) :
The presence of a handwashing station that has both soap AND water
The presence of any soap available in the bari, available within one minute of fieldworker’s request to see the soap
Demonstration of use of soap to wash hands after hypothetical respiratory secretions contact event
For baris who were randomized to the intervention group, the fieldworker will assess whether cue cards provided as part of the intervention are visible in the bari and, if not visible, available within one minute of the fieldworker’s request to see them
The FRA will return to the bari 4-6 weeks later and collect the same information. This repeated collection will help us to determine if there is any reactivity to our follow-up visit in changing handwashing behavior.
Two to three months after the initial follow-up visit, the FRA will return to the bari and once again collect the same information on the handwashing behavior but will also provide SmartSoap to the bari. A SmartSoap is a bar of soap with a motion sensor embedded in the soap that will allow us to measure the number of times the soap is used per day per capita. The FRA will collect the SmartSoap three days later. Data from the SmartSoap will be used to calculate the number of soap use events in the bari. In total an FRA will visit the household a total of four times, three visits for data collection and one visit to collect the SmartSoap.
The FRA will use Appendix 19: Follow Up Soap Tracking Form to record information on the soap that is given to the bari, such as the date the soap was given, and the location the soap was placed within the bari.
Specific aim 5: To assess if exposure to the BISTIS intervention results in a reduced risk of respiratory infections, diarrhea, and influenza.
Methods for Specific Aim 5
The measurements of the health outcomes will be done in two different ways. At the first visit, after the handwashing behavior information is collected, the FRA will record whether each member of the bari has had symptoms of fever, cough, sore throat, difficulty breathing, or diarrhea in the previous 48 hours (Appendix 20: BISTIS Follow Up Visit Illness Tracking Form). At this time the FRA will ask about known danger signs of respiratory illness or diarrhoea, and if any member has these signs, the FRA will refer him/her to JIMCH for care.
Symptoms of respiratory illness and diarrheoa will be collected at each subsequent visit.
At the third visit, in April 2010, the FRA will record mobile phone numbers of two or three bari members. The FRA will identify a key informant, who will be able to provide information regarding fever in any bari member. The FRA will phone the bari once each week during the influenza season and speak with the key informant once per week to assess whether any bari member has had fever during the previous 3 days (Appendix 21a: BISTIS Follow Up Study Phone Call Illness Tracking Form: Ages ≥ 5 Years Old). If any member is reported to have a fever, we will dispatch an MO or lab/medical technician to the bari to obtain nasopharyngeal swab from that member for flu testing by PCR. A case will be defined as: RT-PCR confirmed Influenza virus infection (A or B) (Appendix 11: Secondary/Follow Up Case Specimen Collection Form). The medical technologist will obtain informed consent/assent for specimen collection for all follow up contacts (appendix 2– Adult Consent Form: Specimen Collection, Appendix 3—Parental Guardian Consent Form: Specimen Collection, Appendix 4—Child Assent Form: Specimen Collection).
The FRA will use Appendix 17: Follow Up Bari Eligibility Form to track the eligibility of the bari for the follow up study, as well as to track any drop outs from the follow up phase.
Measures of interest
The following factors are potential risk factors for intrahousehold transmission of influenza. We have excluded here routine demographic factors, such as age and number of years of education since those will be collected directly using a structured questionnaires and the household contact enumeration sheet (appendix 8 – enumeration of household contacts, appendix 9– household questionnaire/ observations).
Socioeconomic status: We will construct an SES index using principal components analysis based on previously described methods.[22] Asset scores from principal components analysis will allow us to assign households to SES quartiles.
Crowding: We will calculate a crowding index based on the number of persons residing in a structured divided by the number of rooms (excluding the kitchen and bathroom) available in that structure. Since, in baris, there are multiple structures and a given individual typically sleeps and lives within only one of those structures, the crowding index for each household contact will take into account the total number of persons living in his/her structure and the number of rooms within that structure.
Ventilation: Ventilation of the home will be assessed by a tool used elsewhere in Bangladesh. In each structure in the bari, we will identify the kitchen space and the main sleeping space of the index case. In each of those, we will count the number of walls, the availability of doors and windows, and the presence of spaces between walls and ceilings, and spaces between walls and floors. We will develop a scale using this information to assign kitchen spaces and sleeping spaces to strata of ventilation.
Indoor air pollution: We will use the UCB Particle Monitor, which has been validated and used in research studies in India, Nepal, and elsewhere in sub-Saharan Africa and Latin America.[23-24] The UCB Particle Monitor measures concentrations of particulate matter < 50 microns (PM50). The monitor will be placed for 24 hours in the sleeping space of the index case-patient . Placement of the monitor will occur within 72 hours of enrollment into the study to ensure that we measure particulate matter concentrations when influenza transmission is most likely to occur. (Appendix 13: Air Monitor Form). For baris that contain a fully enclosed cooking area (four full walls with an entrance) we will also collect AQM data within the cooking area.
Respiratory hygiene: We will inquire about whether the respondent sneezes or coughs directly into her hands, or into a kerchief or other cloth. In addition, we will inquire about whether the respondent washes hands after they come into contact with nasal secretions. This information is self-reported.
Active smoking: Smoking related behaviors will be elicited using questions from the Global Adult Tobacco Survey (GATS) and the Global Youth Tobacco Survey (GYTS), which are validated tools being utilized internationally in 15 countries, as part of the Bloomberg Global Initiative to Reduce Tobacco Use. We will inquire about whether the individual used any smoked tobacco products within the previous 30 days and determine where the individual ever used those products inside the home.
Passive exposure to smoking: Since we will collect information about direct smoking by all household contacts, we will be able to determine whether passive exposure to smoking occurs within each structure in the bari.
Availability of soap and water at a handwashing station: We will identify the location, if any, that the household primarily uses to wash hands. We will inspect whether any cleansing agent (e.g., soap, detergent, mud) and water are available at that location.
Application of Social Cognitive Theory constructs to handwashing promotion for prevention of secondary transmission of influenza[21]
|Construct |Definition |Example of application in proposed intervention |
|Environment |Factors physically external to the person |The FIS will ensure that the environment facilitates handwashing behavior by |
| | |ensuring, on a daily basis, that the tools of soap and water are present at a|
| | |convenient handwashing station in the bari. |
|Situation |Person’s perception of the environment |The FIS will strive to understand perceived barriers to handwashing with soap|
| | |and influenza prevention among bari members, and help the bari members to |
| | |overcome these barriers. Expected barriers include perceptions of soap |
| | |affordability, inability to keep soap at an outdoor handwashing station for |
| | |fear of theft by humans or crows, lack of time to wash hands during busy |
| | |household or child-rearing tasks, and perception that influenza / respiratory|
| | |illness transmission within household members is inevitable. |
|Behavioral capability |Knowledge and skill to perform a given behavior |The FIS will demonstrate, on a daily basis, the proper way to wash hands with|
| | |soap. She will remind all bari members daily about the critical times to |
| | |wash hands, as outlined below. |
|Expectations |Anticipatory outcomes of a behavior |The FIS will reinforce to bari members the need to prevent influenza |
| | |transmission, and the role that handwashing is expected to play in preventing|
| | |influenza transmission. |
|Expectancies |The values that the person places on a given outcome; |The FIS will assess the positive and negative expectancies, as perceived by |
| |incentives |bari members. She will emphasize the positive potential health, educational,|
| | |and economic consequences of preventing influenza transmission to bari |
| | |members, especially the young, the elderly, and those working outside the |
| | |home |
|Observational learning |Behavioral acquisition that occurs by watching the |The FIS will demonstrate on a daily basis, if needed, the appropriate way to |
| |actions and outcomes of others’ behavior |wash hands with soap following critical times. More importantly, she will |
| | |engage key bari members, such as the head of the bari, mothers, and |
| | |school-aged children to act as models of good handwashing behavior in order |
| | |to provide vicarious reinforcement to those under their sphere of influence. |
|Reinforcements |Responses to a person’s behavior that increase or |The FIS will provide direct reinforcement by complimenting, on a daily basis,|
| |decrease the likelihood of reoccurrence |the maintenance of a designated handwashing station fully stocked with water |
| | |and soap, and the demonstration of appropriate handwashing with soap by bari |
| | |members. She will engage children and mothers to provide direct |
| | |reinforcements to fellow bari members in her absence. |
|Self-efficacy |The person’s confidence in performing a particular |By engaging bari members in active learning of handwashing with soap during |
| |behavior and in overcoming barriers to that behavior |her daily visits, the FIS will encourage self-efficacy. In addition, |
| | |ensuring the availability of a fully stocked convenient handwashing station |
| | |will promote self-efficacy. |
|Reciprocal determinism |The dynamic interaction of the person, behavior, and |The FIS will highlight, on a daily basis, the positive steps being taken by |
| |the environment in which the behavior is performed |individuals and the bari as a whole to move all bari members towards better |
| | |handwashing behavior. She will provide positive reinforcement directly and |
| | |encourage bari members themselves to provide mutual reinforcement in order to|
| | |achieve the common good of improved handwashing behavior. The FIS will |
| | |ensure that, on a daily basis, the facilitating tools necessary to wash hands|
| | |will be in place. |
These constructs and definitions are verbatim from Glanz et al, Health Behavior and Health Education: Theory, Research, and Practice, 3rd edition.[21]
Critical times to wash hands with soap are:
After coughing or sneezing
After cleaning one’s nose or the nose of a child
After defecation
After cleaning a child who has defecated
Before preparing food
Before eating
Facilitating tools for handwashing are:
A designated handwashing station at a convenient location for most or all bari members
Soap available daily at the handwashing station
Water available daily at the handwashing station
Laboratory methods
Nasal swab and oropharyngeal swab specimens will be collected using methods already in place at the Jahurul Islam Hospital for HBIS. Compared to nasopharyngeal washes, nasal swabs have been shown to have sensitivity and specificity of 91% and 100% in detecting influenza among children 2 weeks to 15 years old in a small study from Finland.[25] Also, among children < 18 years (median age 1.1 year) nasal and throat swab pairs performed similarly (92% sensitivity) to nasopharyngeal washes in identifying influenza A virus.[26] Among adults, throat swabs were less sensitive in identifying influenza than nasopharyngeal aspirates, when viral culture was the gold standard (47% sensitivity).[27] Among children < 18 years, throat swabs were less sensitive (83%) than nasopharyngeal swab for detecting respiratory viruses with nucleic acid amplification.[28] There is no published data on the yield of nasal swabs or nasal and throat swab pairs compared to naspharyngeal wash or swab for seasonal influenza detection in persons older than 15 years old. Oropharyngeal swabs are preferred over nasal or nasophayngeal swab for detection of human H5N1 infection.[29] Nasal and throat swabs are used in HBIS due to increased acceptability by patients and less technical expertise to perform compared to nasopharyngeal washes or swabs, and increased likelihood of detecting all influenza viruses (including A(H5N1).
From index case-patients, a nasal swab for testing using the QuickVue® (Quidel® Corporation). The QuickVue® uses monoclonal antibodies for direct detection of Influenza A and B and can be used with nasal swabs, nasopharyngeal swabs, nasal washes, or nasal aspirates. The QuickVue test has been shown to have a sensitivity of 78% when using specimens collects with nasal swabs; the specificity has been shown to be 97 to 98%[30]. During the influenza season, QuickVue® has a positive predictive value of 94%, when compared with RT-PCR, for detection of influenza for residents of the Kamalapur slum in Dhaka, Bangladesh (WA Brooks, personal communication). Since the PPV of QuickVue® is estimated to be so high, we are not adjusting the required sample size of index case-patients in order to allow for false positive QuickVue® tests.
After the QuickVue test, another nasal swab and an oropharyngeal swab will be collected from index case-patients and immediately placed into VTM. The VTM will be placed in a cool box (4⁰C) and transferred to a liquid nitrogen dewer at the end of the day for eventual transport to ICDDR,B for RT-PCR testing.
From ill household contacts meeting the case definition, a nasal swab and an oropharyngeal swab will be collected and placed into VTM. This will occur for ill contacts during follow up as well. The VTM will be placed immediately in a cool box with ice (4⁰C). The VTM will then be placed in a liquid nitrogen dewer at the end of the day for eventual transport to the ICDDR,B virology laboratory in Dhaka for RT-PCR testing. Samples will also be stored for future testing of non-influenza respiratory illnesses.
At ICDDR,B, RT-PCR will be done to detect Influenza A (H1N1), novel Influenza A (H1N1) Influenza A (H3N2), Influenza B, and Influenza A (H5N1), with appropriate using standardized laboratory methods already in place.[31]
Timeline:
[pic]
Updated Timeline:
|Activities |2009 |2010 |2011 |
| |10 |11 |12 |1 |
|999,999 |20% |3% |682 |68 |
|999,999 |20% |7% |125 |13 |
|999,999 |20% |10% |61 |6 |
|999,999 |10% |3% |384 |38 |
|999,999 |10% |5% |138 |14 |
|999,999 |10% |7% |71 |7 |
As detailed below, Specific Aim 2 entails promotion of handwashing with soap and improved respiratory hygiene in an intervention group of index case-patients and their households. Therefore, Specific Aim 1 will be answered based on the natural history of intrahousehold transmission, which will be evident in the routine practices group. If, as proposed for Specific Aim 2, we enroll 100 households in the routine practices group, we will be able to describe all of the scenarios in the table above.
Sample size calculation for Specific Aim 2
Sample size calculations for this controlled intervention study were based on the proportion of household contacts of index cases in each group that will become secondary cases. We assumed that standard deviations in the proportion of household contacts that become secondary cases will be the same in the intervention and routine practices groups. Sample sizes below were estimated at the 95% confidence level to achieve 80% power. We assume 10 contacts per household (excluding the index case-patient), as described under Sample size calculation for Specific Aim 1. In previous studies, the secondary attack ratio of respiratory illness or influenza has ranged from 8% to 17% among household contacts, with the 8% SAR for influenza detected in a pilot study in Hong Kong of non-pharmaceutical interventions.[32-34] Since we do not already have SAR data from Bangladesh, we performed sample size calculations based on estimates of 30%, 20%, and 10% SAR in the routine practices group, and relative risk reductions of 50% and 33%. We propose a design effect of 2.0 to account for clustering of secondary cases within households.[17, 35]
|Routine practices |Intervention group* |Relative risk |# household |# households in each |# households in both|# households in both arms |
|group* (%) |(%) |reduction (%) |contacts in each |arm |arms |after applying design |
| | | |arm | | |effect of 2.0 |
|30 |15 |50 |119 |12 |24 |48 |
|30 |20 |33 |292 |29 |58 |117 |
|20 |10 |50 |195 |20 |39 |78 |
|20 |13.4 |33 |497 |50 |99 |199 |
|10 |5 |50 |424 |42 |85 |170 |
|10 |6.7 |33 |1093 |109 |219 |437 |
*This is the secondary attack ratio among household contacts of index case-patients.
After taking into account a design effect of 2.0, we propose a minimum sample size of 39 households per study arm or a total of 78 households.
We expect that, in one influenza season at Jahurul Islam hospital, we will identify about 80 Influenza A and B cases per month. Assuming that there are three months during the 2009 influenza season (this appears to vary a bit from year to year), we anticipate a total of 240 Influenza cases detected during 2009 at Jahurul Islam Hospital. A number of these patients may not be the index case-patients in the home and, thus, would not be eligible for the study. Weighing sample size calculations with eligibility criteria and logistical realities, we estimate that we will be able to enroll a maximum sample size of 100 households per study arm or 200 households. This would allow us to detect all of the differences in the SAR shown above except for the last scenario.
Sample size calculations for Specific Aim 3
The sample size calculation for this cohort investigation is based on the proportion of index cases that are less than 5 years old (Tsolia, Vaccine, 2006). In that study set in Greece, 31% of siblings of children with influenza who were less than 5 years old developed respiratory illness, compared to 19% of siblings of children with influenza who were 5 years or older. We do not have published data on the relative burden of influenza on persons > 5 years old, compared to persons < 5 years old from Bangladesh. Thus, we assume that 33% of our index case-patients are < 5 years old. We expect 10 susceptible contacts per household, as outlined under Sample size calculation for Specific Aim 1, and assume that the secondary attack ratios of influenza among siblings and other household contacts are similar. We performed sample size calculations based on several estimated SARs, and relative risks of 2.0, 1.5, and 1.2 for each estimated SAR. These findings are expected to be significant at p=.05 with 80% power. To account for clustering of secondary transmission within households, we propose a design effect of 2.0.
Here, exposure is defined as the index case-patient’s age being < 5 years. Non-exposure is defined as the index case-patient’s age being > 5 years. As appropriate for cohort studies, we indicate the attack rate among exposed and the attack rate among non-exposed, and the resultant relative risk. The SAR indicates the secondary attack ratio of RT-PCR confirmed Influenza virus infection among all household contacts of the index case-patient.
|SAR among |SAR among |Relative risk|# household |# household |Total # |Total # |Total # households |
|non-exposed (%)|exposed (%) | |contacts of |contacts of |household |households |after applying |
| | | |index |index |contacts | |design effect of 2.0|
| | | |case-patients >|case-patients |case-patients 25 |
|c) Letters, editorials, annotations, and abstracts in peer-reviewed journals |6 |
|Working papers | |
|Monographs/reports |8 |
6 Five recent publications including publications relevant to the present research protocol
Rahman M, Hassan ZM. Zafrul H, Saiada F, Banik A, Faruque ASG, Delbeck T, Matthijnssens J, van Ranst M, Azim T. Sequence analysis and evolution of group B rotaviruses. Virus Research 2007 125:219-225.
Brooks WA, Terebuch P, Bridges C, Klimov A, Goswami D, Sharmeen AT, Azim T, Erdman D, Hall H, Luby S, Breiman RF. Influenza A and B in children inurban slum, Bangladesh. Emerg Inf Dis 2007 (Oct).
Brooks WA, Erdman D, Terebuch P, Klimov A, Goswami D, Sharmeen AT, Azim T, Hall H, Luby S, Bridges C, Breiman RF. Human metapneumovirus infection among children, Bangladesh. Emerg Inf Dis 2007 13:1611-1613.
Azim T, Rahman M, Alam MS, Chowdhury IA, Khan R, Reza M, Rahman M, Chowdhury EI, Hanifuddin M, , Rahman ASMM., Bangladesh moves from being a low prevalence nation for HIV to one with a concentrated epidemic in injecting drug users. Int J STD AIDS 2008 (in press).
Sarker MS, Rahman M, Yirrell D, Khan R, Campbell E, Islam LN, Azim T. Molecular evidence for polyphyletic origin of human immunodeficiency virus type 1 subtype C in Bangladesh. Virus Research 2008 (in press).
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
1 Name: Eduardo Azziz-Baumgartner
2 Present Position: Scientist, Programme on Infectious Diseases and Vaccine Sciences, ICDDR,B
3 Educational background:
(last degree and diploma & training
relevant to the present research proposal)
Bachelors in Science, Molecular Biology (1993)
University of Michigan, Ann Arbor, Michigan
Medical School, (1997)
University of Alabama Medical School, Birmingham, Alabama
Residency, Family Medicine (2000)
University of Texas at San Antonio, San Antonio, Texas
Fellowship in Minority Health Policy, Commonwealth Fund (2003)
Harvard Medical School, Boston, Massachusetts
Masters in Public Health, Family and Community Medicine Health (2003)
Harvard School of Public, Boston, Massachusetts
Epidemic Intelligence Service, National Center for Environmental Health Division of Environmental Hazards and Health Effects, Health Studies Branch (2003-2005)
4.0 List of ongoing research protocols
(start and end dates; and percentage of time)
As Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
As Co-Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
As Co-Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
5 Publications
|Types of publications |Numbers |
|Original scientific papers in peer-review journals |13 |
| Peer reviewed articles and book chapters | |
|Papers in conference proceedings |1 |
|Letters, editorials, annotations, and abstracts in peer-reviewed journals | |
|Working papers |0 |
|Monographs | |
6 Five recent publications including publications relevant to the present research protocol
Eduardo Azziz-Baumgartner, George Luber, Helen Schurz Rogers, L. Backer, M. Belson, Stephanie Kieszak, K. Caldwell, B Lee, R Jones, R Todd, and Carol Rubin. Exposure assessment of a mercury spill in a Nevada school—2004Clinical Toxicology. 2007. Volume 45. 1–5.
Heather Strosnider, Eduardo Azziz-Baumgartner, Marianne Banziger, Ramesh V. Bhat, Robert Breiman, Marie-Noel Brune, Kevin DeCock, Abby Dilley, John Groopman, Kerstin Hell, Sara H. Henry, Daniel Jeffers, Curtis Jolly, Pauline Jolly, Gilbert N. Kibata, Lauren Lewis, Xiumei Liu, George Luber, Leslie McCoy, Patience Mensah, Marina Miraglia, Ambrose Misore, Henry Njapau, Choon-Nam Ong, Mary T.K. Onsongo, Samuel W. Page, Douglas Park, Manish Patel, Timothy Phillips, Maya Pineiro, Jenny Pronczuk, Helen Schurz Rogers, Carol Rubin, Myrna Sabino, Arthur Schaafsma, Gordon Shephard, Joerg Stroka, Christopher Wild, Jonathan T. Williams, and David Wilson. Workgroup Report: Public Health Strategies for Reducing Aflatoxin Exposure in Developing Countries. Environmental Health Perspectives. 2006. Volume 114. 1898–1903
Alberto B. Broce; Ludek Zurek; James A. Kalisch; Robert Brown; David L. Keith; David Gordon; Janis Goedeke; Cal Welbourn; John Moser; Ronald Ochoa; Eduardo Azziz-Baumgartner; Fuyuen Yip; Jacob Weber. Pyemotes herfsi (Acari: Pyemotidae), a Mite New to North America as the Cause of Bite Outbreaks. Journal of Medical Entomology. 2006. Volume 43. (3) 610 – 613.
Eduardo Azziz-Baumgartner; Wolkin, Amy; Sanchez, Carlos; Bayleyegn, Tesfaye; Young, Stacy; Kieszak, Stephanie; Oberst, Kathleen; Batts, Dahna; Thomas, Charles C.; Rubin, Carol. Impact of Hurricane Ivan on Pharmacies in Baldwin County, Alabama. Journal of the American Pharmacists Association. 2005. Volume 45. (6) 670-675.
Eduardo Azziz-Baumgartner, Kimberly Lindblade, Karen Gieseker, Helen Schurz Rogers, Stephanie Kieszak, Henry Njapau, Rosemary Schleicher, Leslie F. McCoy, Ambrose Misore, Kevin DeCock, Carol Rubin, Lawrence Slutsker, and the Aflatoxin Investigative Group. Case-Control Study of an Acute Aflatoxicosis Outbreak - Kenya--2004 Environmental Health Perspectives 2005. Vol. 113 (12) 1779-1783.
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
1 Name: Joseph S. Bresee
2 Present Position: Chief, Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA USA
1986-1990 M.D., Baylor College of Medicine, Houston, TX
1990-1993 Internship/Residency in Pediatrics, University of Washington School of Medicine/Children's Hospital and Medical Center, Seattle, WA
1993-1995 Epidemic Intelligence Service (EIS)
Influenza Branch
Division of Viral and Rickettsial Diseases
National Center for Infectious Diseases
Centers for Disease Control and Prevention
3 Educational background:
(last degree and diploma & training
relevant to the present research proposal)
4.0 List of ongoing research protocols
(start and end dates; and percentage of time)
Dr. Bresee is Chief, Epidemiology and Prevention Branch, Influenza Division at the Centers for Disease Control and Prevention in Atlanta. The EPB is responsible for conducting influenza surveillance, working to understand influenza disease burden, helping to derive appropriate vaccine and antiviral use policies to prevent seasonal influenza, detecting and preventing avian influenza and pandemic influenza, and providing technical expertise to global public health partners. As such, Dr. Bresee is a collaborator on several influenza research studies, but only those related to Bangladesh are listed below.
As Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
As Co-Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
As Co-Investigator
|Protocol Number |Starting date |End date |Percentage of time |
|CDC IRB #4030 |2003 |Sept 2008 |5% |
|CDC IRB#4314 |2003 |Dec 2007 |2% |
| | | | |
| | | | |
Both of these protocols are ICDDR,B studies. CDC IRB#4030 is a surveillance study in Kamalpur, (PI Dr. Brooks). CDC IRB# 4314 is a study of effects of air pollution on respiratory disease (PI – Dr. Brooks)
5 Publications
|Types of publications |Numbers |
|Original scientific papers in peer-review journals |85 |
| Peer reviewed articles and book chapters |135 |
|Papers in conference proceedings |5 |
|Letters, editorials, annotations, and abstracts in peer-reviewed journals |3 |
|Working papers |10 |
|Monographs |0 |
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
NAME W. Abdullah Brooks, MD, MPH
POSITION TITLE
Head, Infectious Diseases Unit, Division of Health Systems and Vaccine Sciences, ICDDR,B – Centre for Health and Population Research
Asst. Scientist , Department of International Health, Johns Hopkins University School of Hygiene and Public Health
EDUCATION
|Institution/Location |Degree |Year Conferred |Field of Study |
|Stanford University |MD |1991 |Medicine |
|The New York Hospital / Cornell Medical |Diploma |1994 |Pediatrics |
|Center | | | |
|Johns Hopkins University |MPH |1995 |International Health |
|Johns Hopkins University |Diploma |1996 |Preventive Medicine |
EXPERIENCE AND APPOINTMENTS
|Year |Activity |
|2007 – Present |Co-Investigator: National influenza hospital surveillance, Bangladesh |
|2006 – 2007 |Co-PI: Efficacy Zinc in outpatient bronchiolitis in children < 2 y/o |
|2006 – Present |Co-Inv: Role of prolactin in diagnosis of pneumonia in children |
|2003 – Present |Principal Investigator: Efficacy Zinc in Outpatient Pneumonia in Children < 2 y/o |
|2003 – Present |Principal Investigator: Pneumococcal disease burden urban study |
|2003 – Present |Principal Investigator: Influenza, other respiratory virus burden of diesase |
|2002 – 2004 |Typhoid burden of disease and risk factor study |
|2002 – 2003 |Principal Investigator: Safety, Immunogenicity, Tolerability CAIV-T (Influenza) vaccine and MMR |
|2002 – 2003 |Prevalence & risk factors for asthma among urban children, Dhaka |
|2002 – Present |Unit Head, Infectious Diseases; Division of Health Systems & Infectious Disease |
|2001 – 2002 |Co-PI: Safety, Immunogenicity, Tolerability CAIV-T (Influenza) vaccine and OPV |
|2001 – Present |Co-PI: Shigella burden of disease study |
|2001 – 2002 |Principal Investigator: Typhoid burden of disease in urban Dhaka |
|2000 – Present |Principal Investigator: Community-based Emergency Epidemiological Study Dengue |
|1999 – 2001 |Principal Investigator: Hospital-based study of efficacy zinc as adjuvant therapy in management severe |
| |pneumonia, hospitalised children < 2 y/o |
|1998 – Present |Principal Investigator: Demographic Surveillance System, Kamalapur, Dhaka |
|1998 – 2001 |Principal Investigator: Community-based study to prevent pneumonia/diarrhoea with zinc in children less than|
| |2 years old |
|1997 – Present |Regional Medical Consultant: International SOS, Singapore |
|1997 – 2001 |Principal Investigator: Hospital-based study to test efficacy zinc in acute watery diarrhoea in children |
| |less than 6 months old |
|1997 – Present |Paediatric Consultant, UNOCAL |
|1997 – Present |Regional Medical Consultant: International SOS, Singapore |
|1997 – 2001 |Paediatric Consultant, US Embassy, Dhaka |
|1996 – 1997 |Chief Resident Preventive Medicine Program, Johns Hopkins University |
|1996 |EPI Technical Advisor: National measles vaccination campaign children 12 - 59 months, PAHO, EPI/SVI, |
| |Georgetown, Guyana |
|1996 |Epidemiologist: Consultants in Epidemiology and Occupational Health, Washington, DC |
|1995 – 1997 |Paediatric Emergency Room Attending, St. Joseph’s Hospital, Baltimore |
|1995 – 1997 |Paediatric consultant: Urban school-based clinics for Baltimore County |
|1994 – 1997 |Paediatric On-Call Physician, Kennedy-Krieger Institute, Johns Hopkins |
|1995 |Multicentre Study on Lower Osmolar ORS, International Centre for Diarrhoeal Disease Research, Bangladesh |
| |(ICDDR,B) |
|1992 |Investigator: Community-based dysentery intervention urban slum children, Salvador, Bahia, Brazil |
|1990 |Epidemiology Intelligence Service Medical Student Clerkship, Enteric Branch, Centers for Disease Control and|
| |Prevention |
|1986 |Investigator: Isolation of L. major attachment proteins, National Institutes of Health |
|1985-1986 |Principal Investigator: Identification of heat-shock proteins in F.hepatica, Stanford University |
Honours and Awards (Selected)
Time Magazine 2005, ‘The year in medicine’ recognition of Brooks et al. Lancet, 2005. 366(9490): p. 999-1004 contribution to child mortality reduction
Awardee Office of Dietary Supplements, National Institutes of Health, 100 most significant advances in Annual Bibilography of Significant Advances in Dietary Supplement Research 2004 for Brooks et al. Lancet, 2004. 363(9422): p. 1683-8.
Chief Residency, Preventive Medicine, Johns Hopkins University School of Public Health 1996 – 7
Awardee Health & Child Survival Scholarship to Johns Hopkins University 1994 – 5
Selectee Ciba-Geigy Medical Student (competitive) Scholarship for internship NIH 1985 while at Stanford Medical School
PUBLICATIONS (Selected)
Brooks, W.A., Breiman, R. F., Goswami, D., Hossain, A., Alam, K., Saha, S. K., Nahar, K., Nasrin, D., Ahmed, M. D., Arifeen, S. E., Naheed, A., Sack, D. A., Luby, S. , Invasive pneumococcal disease burden, seasonality, and antimicrobial resistance patterns, and implications for vaccine policy in urban Bangladesh. In Press, 2007.
Ram, P.K., Naheed, A., Brooks, W.A., Hossain, M.A., Mintz, E.D., Breiman, R.F., and Luby, S.P., Risk factors for typhoid fever in a slum in Dhaka, Bangladesh. Epidemiol Infect, 2007. 135(3): p. 458-65.
Islam, M.S., Brooks, A., Kabir, M. S., Jahid, I. K., Islam, M. S., Goswami, D., Nair, G. B., Larson, C., Yukiko, W., Luby, S., Faecal contamination of drinking water sources of Dhaka during the 2004 flood in Bangladesh and use of disinfectants for water treatment. J Appl Microbio, 2006.
Brooks, W.A., Santosham, M., and Black, R.E., Zinc, infectious diseases, and low birth weight. Am J Clin Nutr, 2006. 84(3): p. 667.
Harris, J.B., Baresch-Bernal, A., Rollins, S.M., Alam, A., LaRocque, R.C., Bikowski, M., Peppercorn, A.F., Handfield, M., Hillman, J.D., Qadri, F., Calderwood, S.B., Hohmann, E., Breiman, R.F., Brooks, W.A., and Ryan, E.T., Identification of in vivo-induced bacterial protein antigens during human infection with Salmonella enterica serovar Typhi. Infect Immun, 2006. 74(9): p. 5161-8.
Brooks, W.A., Santosham, M., Naheed, A., Goswami, D., Wahed, M.A., Diener-West, M., Faruque, A.S., and Black, R.E., Effect of weekly zinc supplements on incidence of pneumonia and diarrhoea in children younger than 2 years in an urban, low-income population in Bangladesh: randomised controlled trial. Lancet, 2005. 366(9490): p. 999-1004.
Brooks, W.A., Hossain, A., Goswami, D., Nahar, K., Alam, K., Ahmed, N., Naheed, A., Nair, G.B., Luby, S., and Breiman, R.F., Bacteremic typhoid fever in children in an urban slum, Bangladesh. Emerg Infect Dis, 2005. 11(2): p. 326-9.
Brooks, W.A., Santosham, M., Roy, S.K., Faruque, A.S., Wahed, M.A., Nahar, K., Khan, A.I., Khan, A.F., Fuchs, G.J., and Black, R.E., Efficacy of zinc in young infants with acute watery diarrhea. Am J Clin Nutr, 2005. 82(3): p. 605-10.
LaRocque, R.C., Breiman, R.F., Ari, M.D., Morey, R.E., Janan, F.A., Hayes, J.M., Hossain, M.A., Brooks, W.A., and Levett, P.N., Leptospirosis during dengue outbreak, Bangladesh. Emerg Infect Dis, 2005. 11(5): p. 766-9.
Brooks, W.A., Yunus, M., Santosham, M., Wahed, M.A., Nahar, K., Yeasmin, S., and Black, R.E., Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial. Lancet, 2004. 363(9422): p. 1683-8.
RELEVANT MANUSCRIPTS UNDER REVIEW
Brooks, W.A., Terebuh, P., Bridges, C., Klimov, A., Goswami, D., Sharmeen., Azim, T., Erdman, D., Hall, H., Luby, S., Breiman, R.F., Influenza A and B infection among children in an urban slum of Dhaka, Bangladesh: A pilot study. Manuscript submitted and under review, 2007.
Brooks, W.A., Erdman, D., Terebuh, P., Klimov, A., Goswami, D., Sharmeen., Azim, T., Luby, S., Bridges, C., Breiman, R.F., Human metapneumovirus infection among children in an urban slum of Dhaka, Bangladesh: A pilot study. Manuscript submitted and under review, 2007.
BOOKS/GUIDELINES
Guidelines for the control of shigellosis, including Shigella dysenteriae type 1. WHO 2005
GRANTS
Health and Human Services: Population-based influenza surveillance among children < 5 years old in Kamalapur in Dhaka, Bangladesh. US $250,000 2006 - 2007
Thrasher Research Foundation: Efficacy of Zinc in the Treatment of Outpatient Pneumonia Among Urban Slum Children Less than Two Years Old. US $250,000; 2004 – 2007
Centers for Disease Control and Prevention: Surveillance for influenza and the viral aetiologies of influenza-like febrile illnesses in an urban slum in Dhaka, Bangladesh US $392,133; 2004-2008
Accelerated Development and Introduction Plan (ADIP): Burden of Pneumococcal Disease in children in Bangladesh: A Project to Enhance Laboratory Capacity and Create Awareness, and to Prepare for Introduction of a Pneumococcal Vaccine. US $599,816; 2004 – 2008
Bill & Melinda Gates Foundation: Efficacy of Zinc in the Treatment of Outpatient Pneumonia Among Urban Slum Children Less than Two Years Old. US $250,591; 2004 – 2007
Wyeth: A Prospective, Randomized, Double Blind, Placebo-Controlled, Trial to Assess Safety, Efficacy, Tolerability and Immunogenicity of Influenza Virus Vaccine, Trivalent, Types A & B, Live Cold-Adapted, Liquid Formulation (CAIV-T), Administered Concomitantly with a Combination Live, Attenuated, Mumps, Measles, and Rubella Vaccine in Healthy Children Aged 11 – 24 Months Protocol No. D153 P522. US $116,419; 2002 – 2003
National Institutes of Health (ICIDR): Emergency epidemiological study of dengue and dengue haemorrhagic fever in Dhaka, Bangladesh. US $100,097; 2002 – 2003
Wyeth: A prospective, randomised, partially-blinded, placebo-controlled, Phase III, multicentre trial to assess safety, tolerability and imunogenicity of liquid influenza virus vaccine, trivalent, types A & B, live cold-adapted (liquid CAIV-T) administered concomitantly with live, attenuated, poliovirus vaccine in healthy children. US $185,845; 2001 – 2002
International Vaccine Institute: Population based evaluation of Shigella infections in an urban area of Dhaka, Bangladesh US $459,672; 2001 – 2004
United States Agency for International Development/Johns Hopkins University: Efficacy of Zinc in the Prevention of Pneumonia in Urban Slum Children in Dhaka, Bangladesh. US $115,102; 1998 – 2001
Swiss Development Corporation: Efficacy of Zinc in the Prevention of Pneumonia in Urban Slum Children in Dhaka, Bangladesh. US $50,000; 1998 - 2001
United States Agency for International Development (USAID): Efficacy of Zinc in the Prevention of Pneumonia in Urban Slum Children in Dhaka, Bangladesh. US $65,000; 1998 – 2001
United States Agency for International Development (USAID): Efficacy of Zinc in the Treatment of Severe Pneumonia Among Hospitalised Children less than Two Years Old. US $62,365; 1999 – 2001
United States Agency for International Development (USAID)/Johns Hopkins University: Efficacy of zinc in treatment of acute watery diarrhoea in infants less than six months old. US $13,355; 1998 – 2000
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
|NAME |POSITION TITLE |
|DiVita, Margaret Anne |PhD Candidate |
|eRA COMMONS USER NAME | |
|n/a | |
|EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) |
|INSTITUTION AND LOCATION |DEGREE |YEAR(s) |FIELD OF STUDY |
| |(if applicable) | | |
|SUNY Geneseo |BA |1999-2002 |Anthropology and Spanish |
|SUNY Binghamton |MS |2002-2004 |BioMedical Anthropology |
|SUNY Buffalo |-- |2004- current |Epidemiology and Community Health |
A. Honors
Honors and Awards
5/2002 Magna Cum Laude, SUNY Geneseo
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
Alicia M. Fry
Centers for Disease Control and Prevention
1600 Clifton Road, Mailstop A-34
Atlanta, GA 30333
Phone: (404) 639-2680
Email: afry@
December 2006
EDUCATION AND TRAINING (Relevant to proposal)
Postgraduate
7/93- 6/95 Infectious Diseases Fellowship (overlapping with Molecular Medicine Fellowship)
University of California, San Francisco
7/90 – 6/93 Internal Medicine Internship and Residency
The Johns Hopkins Hospital, Baltimore, Maryland
Graduate/Undergraduate
6/98-5/99 Masters of Public Health (Epidemiology)
University of California, Berkeley, School of Public Health
9/84-5/90 Doctorate of Medicine
University of Cincinnati College of Medicine, Cincinnati, Ohio
CURRENT POSITION
Centers for Disease Control and Prevention
Medical Epidemiologist
Division of Viral Diseases,
Epidemiology Branch,
National Center for Immunization and Respiratory Diseases
5 PEER-REVIEWED PUBLICATIONS (Relevant to proposal)
Fry AM, Lu X, Peret TDT, Chittaganpitch M, Fischer J, Erdman DD, Olsen SJ. Human bocavirus: a novel parvovirus epidemiologically associated with hospitalized pneumonia in Thailand. J Infect Dis (in press)
Fry AM, Curns A, Harbour K, Anderson LJ. Seasonal Trends of Human Parainfluenza Viruses in the United States; National Respiratory Virus Surveillance Data, 1990-2002, Clin Inf Dis 2006 43(8):1016-22.
Fry, AM, Shay DK, Holman R, Curns A, Anderson LJ. Trends in hospitalizations for pneumonia among persons 65 years of age and older in the United States, 1988–2002. JAMA 2005; 294(21):2712-2719.
Fry AM, Udeagu CC, Soriano-Gabarro M, Fridkin S, Musinski D, LaClaire L, Elliott J, Cook DJ, Kornblum J, Layton M, Whitney CG.. Persistence of a fluoroquinolone-resistant multidrug-resistant Streptococcus pneumoniae in a long-term care facility: Efforts to decrease transmission, Infection Control and Hospital Epidemiology 2005;23: 239-47.
Fry AM, Facklam R, Whitney CG, Plikaytis BD, and Schuchat A. Multi-state evaluation of invasive pneumococcal diseases in adults with HIV infection: serotype and antimicrobial resistance patterns in the United States, J Infect Dis 2003: 181; 643.
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
1 Name: Stephen P Luby
2 Present Position: Head, Programme on Infectious Diseases and Vaccine Sciences.
University of Texas Southwestern Medical School at Dallas
MD, 1986
University of Rochester Strong Memorial Hospital
Internship and residency in Internal Medicine.
Centers for Disease Control -- Epidemic Intelligence Service 1990
Completed Preventive Medicine Residency 1993.
3 Educational background:
(last degree and diploma & training
relevant to the present research proposal)
4.0 List of ongoing research protocols
(start and end dates; and percentage of time)
As Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
|2003-024 |1 Sep 2003 |31 Dec 2006 |5 |
|2005-026 |1 Oct 2005 |31 Dec 2006 |5 |
|2005-023 |1 Feb 2006 |31 Dec 2007 |5 |
|2006-043 |1 Nov 2006 |31 July 2007 |5 |
|2007-003 |1 May 2007 |31 Apr 2008 |3 |
|2007-002 |1 May 2007 |30 Sep 2008 |5 |
|2007-010 |1 July 2007 |30 Sep 2008 |5 |
|2007-004 |1 May 2007 |30 Sep 2008 |1 |
|2007-030 |1 Sep 2007 |31 Dec 2008 |5 |
As Co-Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
|2003-024 |Jun 2004 |June 2006 |5 |
|2003-002 |June2003 |Dec 2006 |5 |
4.3 As Co-Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
5 Publications
|Types of publications |Numbers |
|Original scientific papers in peer-review journals |118 |
| Peer reviewed articles and book chapters |9 |
|Papers in conference proceedings |1 |
|Letters, editorials, annotations, and abstracts in peer-reviewed journals |4 |
|Working papers |0 |
|Monographs |0 |
Five recent publications including publications relevant to the present research protocol
Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: a randomised controlled trial. Lancet. July 15, 2005; 366:225-33.
Ram PK, Naheed A, Brooks WA, Hossain MA, Mintz ED, Breiman RF, Luby SP. Risk factors for typhoid fever in a densely populated slum in Dhaka, Bangladesh. Epidemiology and Infection. 2007 135:458-65.
Bowen A, Huilai M, Ou J, Billhimer W, Long T, Mintz E, Hoekstra RM, Luby S. A Cluster-Randomized Controlled Trial Evaluating the Effect of a Handwashing Promotion Program in Chinese Primary Schools, American Journal of Tropical Medicine and Hygiene. June 2007 76(6):1166-1173.
Brooks WA, Breiman RF, Goswami D, Hossain A, Alam K, Saha S, Narar K, Nasrin D, Ahmed N, El Arifeen S, Naheed A, Sack D, Luby S. Invasive pneumococcal disease burden and implications for vaccine policy in urban Bangladesh. American Journal of Tropical Medicine and Hygiene. 2007 Nov 77(5): 795–801.
Luby SP, Halder AK. Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh. Tropical Medicine and International Health. 2008 Jun 13(6):835-844.
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
1 Name: Mustafizur Rahman
2 Present Position: Senior Research Officer, Virology Laboratory, LSD, ICDDR,B.
1995 M.Sc. in Microbiology, University of Dhaka. Bangladesh.
2001-2002 Training in Virology, University of Leuven, Belgium.
2002 Training in Bio-informatics in Charles University, Prague, Czech Republic.
2007 IEIP/GDD Laboratory Workshop for Respiratory Disease, Centers for Disease Control, Atlanta, USA.
3 Educational background:
(last degree and diploma & training
relevant to the present research proposal)
4.0 List of ongoing research protocols
(start and end dates; and percentage of time)
As Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
As Co-Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
As Co-Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
5 Publications
|Types of publications |Numbers |
|Original scientific papers in peer-review journals |25 |
| Peer reviewed articles and book chapters |1 |
|Papers in conference proceedings |0 |
|Letters, editorials, annotations, and abstracts in peer-reviewed journals |0 |
|Working papers |5 |
|Monographs |0 |
6 Five recent publications including publications relevant to the present research protocol
Rahman, M., J. Matthijnssens, X. Yang, T. Delbeke, I. Arijs, K. Taniguchi, M. Iturriza-Gomara, N. Iftekharuddin, T. Azim, and M. Van Ranst. 2007. Evolutionary history and global spread of the emerging G12 human rotaviruses. J Virol 81:2382-90.
Rahman, M., R. Sultana, G. Ahmed, S. Nahar, Z. M. Hassan, F. Saiada, G. Podder, A. S. G. Faruque, A. K. Siddique, D. A. Sack, J. Matthijnssens, M. Van Ranst, and T. Azim. 2007. Prevalence of G2P[4] and G12P[6] rotavirus, Bangladesh. Emerg Infect Dis 13:18-24.
Rahman, M., Z. M. Hassan, H. Zafrul, F. Saiada, S. Banik, A. S. G. Faruque, T. Delbeke, J. Matthijnssens, M. Van Ranst, and T. Azim. 2007. Sequence analysis and evolution of group B rotaviruses. Virus Res 125:219-25.
Rahman, M., J. Matthijnssens, T. Goegebuer, K. De Leener, L. Vanderwegen, I. Van der Donck, L. Van Hoovels, S. De Vos, T. Azim, and M. Van Ranst. 2005. Predominance of rotavirus G9 genotype in children hospitalised for rotavirus gastroenteritis. J Clin Virology 33:1-6.
Rahman, M., J. Matthijnssens, S. Nahar, G. Podder, D. A. Sack, T. Azim, and M. Van Ranst. 2005. Characterization of a novel P[24],G11 human group A rotavirus. J Clin Microbiol 43:3208-12.
Biography of the Investigators
Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.
(Note: Biography of the external Investigators may, however, be submitted in the format as convenient to them)
1 Name: Rashid Uz Zaman
2 Present Position: Research Investigator, PIDVS, ICDDR,B
Post Graduate Diploma in Health Economics (PGDHE), University of Dhaka
Bachelor of Medicine and Surgery (MBBS), University of Dhaka
3 Educational background:
(last degree and diploma & training
relevant to the present research proposal)
4.0 List of ongoing research protocols
(start and end dates; and percentage of time)
As Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
| | | | |
| | | | |
| | | | |
| | | | |
As Co-Principal Investigator
|Protocol Number |Starting date |End date |Percentage of time |
|2007-002 |Apr 2007 |Apr 2009 |70% |
| | | | |
| | | | |
| | | | |
As Co-Investigator
|Protocol Number |Starting date |End date |Percentage of time |
|2006-054 |Mar 2007 |Jan 2009 |10% |
|2007-010 |Jul 2007 |Jul 2008 |5% |
|2007-031 |Oct 2007 |Oct 2008 |5% |
|2008-001 |May 2008 |Apr 2008 |10% |
5 Publications
|Types of publications |Numbers |
|Original scientific papers in peer-review journals |2 |
| Peer reviewed articles and book chapters | |
|Papers in conference proceedings |2 |
|Letters, editorials, annotations, and abstracts in peer-reviewed journals | |
|Working papers |1 |
|Monographs | |
6 Five recent publications including publications relevant to the present research protocol
1) ICDDR,B, 2008, Hospital based surveillance revealed high prevalence of influenza in Bangladesh. Health Sci Bull 2008; 6(1):1-5
2) Begum B, Zaman R, Ahmed SMU, Ali S. Burst abdomen – a preventable morbidity. Mymensingh Med J. 2008 Jan; 17(1): 63-6
3) Hossain N, Zaman RU, Banks N, Gierbo HC. The incentives and constrains of Government Doctors in Primary Healthcare Facilities in Bangladesh. BRAC/RED Research Report: November 2007
4) Ahmed SMU, Kakehi Y, Zaman RU, Hasan AU. Role of Brachytherapy in curbing prostatic cancer. Bang Med J (Khulna) 2007; 40(1 & 2); 16-19
5) Begum B, Uddin KU, Rahman MA, Habib A, Yeasmin S, Zaman RU. Better management expectation for Pelvic Inflammatory Disease. Bangladesh Medical Journal 2004; 33(4): 132-135
Detailed Budget
[pic]
Budget Justifications
Please provide one page statement justifying the budgeted amount for each major item. Justify use of human resources, major equipment, and laboratory services.
Personnel
PD/PI: A Research Investigator from ICDDR,B will allot 50% of his/her time to oversee all the activities of the study.
Medical Officer: Two full time (100%) Medical Officers will be hired for 8 months on CSA basis who will be stationed in the field site. They will be responsible for identifying index case patients from the selected hospital and collect their samples from the departments of medicine and pediatrics. They will also provide other technical supports to the study including field management.
Lab Research Officer: A full time Research Officer will be hired to support the lab activities during the overall project time period.
Health assistant: Two full time health assistants will be employed to assist in daily logistical and sample collection activities including transport of specimens.
Field research officer: Two FROs are budgeted 100% time to ensure implementation and coordinate the research activities at the community level and also support and oversee the overall activities of the FRAs.
Field research assistants: 12 full time FRAs have been budgeted who will be responsible for field implementation of the planned activities and to collect data from the community. They will work by dividing into two groups (FIS and FRA).
Travel
Local travel: We have budgeted $4,620 to cover the local travel costs associated with the movement by the FROs and FRAs across villages in 3-4 upazillas. This cost will also cover the cost of specimen transport by the FAs from field to ICDDR,B lab.
Per diem for staff: The MOs, FROs, FRAs and the FAs will be stationed in the field site. However their trainings and meetings will be conducted in Dhaka. Moreover, the PI and the other investigators will often pay monitoring visits to the field. For this we have allocated $5,380 to cover all their per diem during the life of the project. The average per diem for all level staff was considered about $20 per night.
Supplies and lab supplies
We have allocated a total of $41,310 for general stock and non-stock items, rapid tests, for handwashing and promotion supplies and for UCB particle monitors and cool boxes. We have also allocated money to buy an EDGE modem for the field staff for communication via internet.
Communications and others
We have budgeted $1200 for internet and mobile phone bill for our field staff and $200 for fax, postage, DHL etc.
Equipment
We will provide a laptop computer with software to the field staff for internet communication and for tracking the field activities. We have kept $1200 for this purpose.
Interdepartmental cost
A total amount of $3,500 is budgeted to cover some of interdepartmental cost like data entry, photocopy and hospitalization/treatment cost of the patients.
Other Support
Describe sources, amount, duration, and grant number of all other research funding currently granted to PI or under consideration.
Appendix 1: Figure and Details about Bari
|[pic] |The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) |[pic] |
| | | |
| |Jahurul Islam Medical College Hospital, Kishorgonj | |
| | | |
Instructions: Draw the overall layout of the bari, including the location of the following:
Entry / entries to bari
Each household within bari
Latrine(s)
Cooking space(s)
Below is an example of a drawing of two baris. You should label your drawing, as shown in the bari on the bottom left.
[pic]
Appendix 2: Adult Consent Form: Specimen Collection
Protocol Number: 2009-004
Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS)
Investigator’s name: Dr. Stephen P. Luby
Organization: ICDDR,B
Name of Index Case Patient: _____________________________________
Unique ID: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Introduction
You are invited to take part in a research trial. Scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University at Buffalo, a university in the USA, are doing a research study to understand factors associated with the spread of influenza virus in a rural population.
Purpose of the research
We are trying to understand factors that are connected to the spread of influenza virus within a bari. We would also like to understand whether washing hands with soap prevents the spread of this illness. Around 400 baris will be part of the study. We will aim to find out whether the spread of influenza is linked to specific behaviors.
Why selected
We are asking you to participate in this study because, in the past 7 days, you have had symptoms of cough and/or sore throat and a fever. These symptoms may be related to an illness called influenza. We are interested in studying this illness.
What is expected from the patient/respondent?
For probable index case-patients ONLY
We ask you to allow one of our trained research personnel to take a swab from your nose. This swab will then be tested for influenza.
We will then take a second swab from your nose and also a swab from your throat. We will use these swabs to test for the type of influenza you may have. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time by calling Dr. Stephen P. Luby at 8860523-32 # 2502.
For probable secondary/follow-up case-patients ONLY
We ask you to allow one of our trained research personnel to take a swab from your nose and throat. These swabs will then be tested for influenza at a later time. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time by calling Dr. Stephen P. Luby at 8860523-32 # 2502.
Risk and benefits
One of our trained research personnel will have to place a swab into your nose and a different swab into your throat. This may be uncomfortable. There are no other known risks for this procedure. There is no specific benefit to you having this test done. Because the results of the swab will not affect your medical care in any way, we will not be providing you with the results of your swab. But, information from the swab that we take from you will help us to understand how the influenza virus is spread within a bari.
Privacy, anonymity and confidentiality
All of the information we collect about you will be kept private and confidential. We will keep all paper documents in a locked cabinet. We will not give any information about you to anyone not involved in the study. Your name will never be used in reports of this study.
Future use of information
If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy.
Right not to participate
You may choose to allow us to take swabs from your nose and throat or not to allow us to take these swabs. You may choose to ask us to stop taking the specimen or to discard the specimen before testing it. Refusal to participate will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to take this specimen, you will still receive the usual care at the hospital. You will not be denied any treatments or benefits for which you would otherwise be eligible. If you choose to allow us to take these swabs, you may choose to allow us to store the specimens or not allow us to store the specimens. You may still participate in the study even if you refuse to allow us to store your specimens. Refusal to allow us to store your specimens will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to store your specimens, you will still receive the usual care at the hospital. You will not be denied any treatments or benefits for which you would otherwise be eligible.
Principle of compensation
There is no cost to you for allowing us to take a nose and/or throat specimen. There will also be no compensation to you.
Persons to Contact:
If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact:
Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502,
If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact:
Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989
If you agree to our proposal of obtaining a nose and/or throat specimen, please indicate that by putting your signature or your left thumb impression at the specified space below.
Thank you for your cooperation
_______________________________________ ____________________
Signature or left thumb impression of subject Date
_______________________________________ ____________________
Signature or left thumb impression of the witness Date
_______________________________________ ___________________
Signature of the PI or his/her representative Date
Appendix 3: Parent or Guardian Consent Form: Specimen Collection
Protocol Number: 2009-004
Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS)
Investigator’s name: Dr. Stephen P. Luby
Organization: ICDDR,B
Name of Index Case Patient: _____________________________________
Unique ID: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Introduction
Your child is invited to take part in a research trial. Scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University of Buffalo, a university in the USA, are doing a research study understand factors associated to the spread of influenza virus in a rural population.
Purpose of the research
We are trying to understand factors that are connected to the spread of influenza virus within a bari. We would also like to understand whether washing hands with soap prevents the spread of this illness. Around 400 baris will be part of the study. We will aim to find out whether the spread of influenza is linked to specific behaviors.
Why selected
We are asking your child to participate in this study because he/she has had in the past 7 days a cough and/or sore throat and a fever. These symptoms are related to an illness called influenza. We are interested in studying this illness.
What is expected from the patient/respondent?
For probable index case-patients ONLY
We ask you to allow one of our trained research personnel to take a swab from your child’s nose. This swab will then be tested for influenza.
We will then take a second swab from your child’s nose and also a swab from your child’s throat. We will use these swabs to test for the type of influenza your child may have. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your child’s swabs removed from storage at any time by calling Dr. Stephen P. Luby
at 8860523-32 # 2502.
For probable secondary/follow-up case-patients ONLY
We ask you to allow one of our trained research personnel to take a swab from your child’s nose and throat. These swabs will then be tested for influenza at a later time. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your child’s swabs removed from storage at any time by calling Dr. Stephen P. Luby
at 8860523-32 # 2502.
Risk and benefits
One of our trained research personnel will have to place a swab into your child’s nose and a different swab into your child’s throat. This may be uncomfortable. There are no other know risks for this procedure. There is no specific benefit to you having this test done. Because the results of the swab will not affect your child’s medical care in any way, we will not be providing you with the results of your child’s swab. But, information from the swab that we take from your child will help us to understand how the influenza virus is spread within a bari.
Privacy, anonymity and confidentiality
All of the information we collect about your child will be kept private and confidential. We will keep all paper documents in a locked cabinet. We will not give any information about your child to anyone not involved in the study. Your child’s name will never be used in reports of this study.
Future use of information
If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy.
Right not to participate
You may choose to allow us to take swabs from your child’s nose and throat or not allow us to take these swabs. You may choose to ask us to stop taking the specimen or to discard the specimen before testing it. Refusal to participate will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to take this specimen, your child will still receive the usual care at the hospital. Your child will not be denied any treatments or benefits for which he/she would otherwise be eligible. If you choose to allow us to take these swabs from your child, you may choose to allow us to store the specimens or not allow us to store the specimens. You may still participate in the study even if you refuse to allow us to store your child’s specimens. Refusal to allow us to store your child’s specimens will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to store your child’s specimens, your child will still receive the usual care at the hospital. Your child will not be denied any treatments or benefits for which you would otherwise be eligible.
Principle of compensation
There is no cost to you or your child for allowing us to take a nose or throat specimen. There will also be no compensation to you or your child.
Persons to Contact:
If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact:
Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502,
If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact:
Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989
If you agree to our proposal of obtaining a nose and/or throat specimen from your child, please indicate that by putting your signature or your left thumb impression at the specified space below.
Thank you for your cooperation.
_______________________________________ ____________________
Signature or left thumb impression Date
of attendant/Guardian
_______________________________________ ____________________
Signature or left thumb impression of the witness Date
_______________________________________ ___________________
Signature of the PI or his/her representative Date
Appendix 4: Child Assent Form: Specimen Collection
Protocol Number: 2009-004
Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS)
Investigator’s name: Dr. Stephen P. Luby
Organization: ICDDR,B
Name of Index Case Patient: _____________________________________
Who are we?
My name is ________ and I work for ____________.
Why are we meeting with you?
We want to tell you about a study that we are doing that involves people with certain symptoms: cough and/or sore throat and fever. These symptoms are associated with an illness called influenza. We are interested in studying this illness.
Why are we doing this study?
We are trying to understand factors that are connected to the spread of influenza within a bari. We want to know if the spread of this illness is connected to any specific behaviors.
What will happen to you if you are in the study?
For possible index case-patients ONLY
We ask you to allow one of our trained research personnel to put a swab into your nose. We will test this swab to test for the influenza virus.
A second nose swab and also a throat swab will then be taken. We will use these swabs to test for the type of influenza you may have. If you agree, we will store the material from the swabs for twenty years. We may test the swabs later for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time. You can do this by calling Dr. Stephen P. Luby
at 8860523-32 # 2502.
For probable secondary/follow-up case-patients ONLY
We ask you to allow one of our trained research personnel to put a swab into your nose and throat. We will test these swabs to test for the influenza virus at a later time. If you agree, we will store the material from the swabs for twenty years. We may test the swabs later for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time. You can do this by calling Dr. Stephen P. Luby at 8860523-32 # 2502.
What are the good things and bad things that may happen to you?
One of our trained research personnel will have to place a swab into your nose and throat; this may be uncomfortable, but this should not hurt you.
Do you have to allow us to take this specimen?
No, you do not. No one will get upset or angry with you if you do not want to do this. Just tell us if you do not want to take part. Remember, you can change your mind later if you decide you don’t want to take part in the study anymore. You also do not have to let us store your specimens. No one will get upset or angry with you if you do not want this. Just tell us if you do not want us to store your specimens. You can still take part in the study even if you do not want us to store your specimens. Remember, you can change your mind later if you decide you no longer want us to store your specimens.
Do you have any questions?
You can ask them at any time. You can ask now, or you can ask later. You can talk to me or you can talk to someone else at any time during the study. You can also call the person below.
Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502
If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact:
Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989
If you want to take part in the study and allow us to take these specimens, please indicate that by putting your signature or your left thumb impression at the specified space below
Thank you for your cooperation
_______________________________________ ____________________
Signature or left thumb impression of subject Date
_______________________________________ ____________________
Signature or left thumb impression Date
of attendant/Guardian
_______________________________________ ____________________
Signature or left thumb impression of the witness Date
_______________________________________ ___________________
Signature of the PI or his/her representative Date
Appendix 5: Consent Form: Study Enrollment, Household/Bari
Protocol Number: 2009-004
Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS)
Investigator’s name: Dr. Stephen P. Luby
Organization: ICDDR,B
Introduction
Your Bari is invited to take part in a research trial. Scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University at Buffalo, a university in the USA, are doing a research study understand factors associated to the spread of influenza virus in a rural population.
Purpose of the research
We are trying to understand factors that are connected to the spread of influenza virus within a bari. We would also like to understand whether washing hands with soap prevents the spread of this illness. Around 400 baris will be part of the study. We will aim to find out whether the spread of influenza is linked to specific behaviors.
Why selected
One of the members of your Bari has been identified as having symptoms that are associated with influenza. This is why we are inviting your Bari to help us.
What is expected from the members of your Bari?
If you agree to enrolling your Bari in the study:
I will identify all the members within each bari.
We will also observe aspects of your Bari that may be related to the spread of influenza-like illness. We will ask questions about each household within the bari and observe the physical characteristics of the households.
We will visit your Bari every day until ten days after the symptoms of the person with influenza-like illness resolve. During those daily visits, we will ask about whether each member of your Bari has influenza-like symptoms.
During our visits, if a member of your bari shows symptoms of influenza-like illness, we will ask that person to allow us to take swabs from the nose and throat. These swabs will be used to test for influenza at a later time.
This study is an intervention trial. This means half the Baris will be taught some new behaviors and given soap during the time period we will be visiting the bari. The remaining Baris will be given soap after we complete the daily visits. The remaining Baris will also be taught the behaviors at a future time. Baris will be assigned to the group that will receive the teaching and soap randomly, so it is beyond our control when each bari receives the teaching and soap.
Risk and benefits
In people who have skin reactions to the soap available at the market, the soap we give you may cause similar reactions. These people should not use the soap we give you. The process of having someone visit your home may be uncomfortable to you. However, we do not expect any harm to come to you or your family because of being visited.
All Baris that take place in the study will receive the benefit of teaching and bars of soap; however there will be no other immediate benefits. However, this study will help us better understand what factors are associated with the spread of influenza within a bari. This study will also help us test prevention methods that may stop the spread of influenza. This study may help us understand how to stop the spread of influenza-like illness within baris in rural Bangladesh.
For those people who have symptoms and who allow us to take a nose and throat swab, one of our trained research personnel will have to place a swab into their nose and a different swab into their throat. This may be uncomfortable. There are no other known risks for this procedure.
The results of the influenza testing will not be available for one or more months after the specimen is collected. The results of the test will not alter in any way the treatment of the person who has influenza related symptoms.
Privacy, anonymity and confidentiality
All of the information we collect about the members of your community will be kept private and confidential. We will keep all data in a locked cabinet. We will not give any information about your community to anyone not involved in the study.
Future use of information
If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy.
Right not to participate and withdraw
You may choose to allow your Bari to take part or not to take part in this study. You may refuse to take part at any time. You may also withdraw your Bari from the study at any time. Refusal to participate or withdrawal from the study will involve no penalty or loss of benefits for the members of your community at the clinic or hospital. Even if you do not enroll your Bari in the study, everyone in your Bari will still receive the usual care at the clinic. Each individual in your Bari may choose to participate or not participate, and may choose to withdraw from the study at any time.
Principle of compensation
There is no cost to you or your bari for participation in this study. Other than receiving free soap, you will not receive any compensation for being in the study.
Persons to Contact:
If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact:
Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502
If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact:
Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989
If you agree to enrolling your Bari in our study, please indicate that by putting your signature or your left thumb impression at the specified space below.
Thank you for your cooperation.
_______________________________________ ____________________
Signature or left thumb impression of subject Date
_______________________________________ ____________________
Signature or left thumb impression Date
of attendant/Guardian
_______________________________________ ____________________
Signature or left thumb impression of the witness Date
_______________________________________ ___________________
Signature of the PI or his/her representative Date
cwiwkó-2t cÖvßeq¯‹‡`i m¤§wZcÎt bgybv msMÖn
M‡elYv b¤^i: 2009-004
M‡elbvi bvgt mvevb w`‡q nvZ †avqvi gva¨‡g †ivM ciewZ© gvby‡li g‡a¨ msµwgZ Bbd¬z‡qÄv msµgb cÖwZ‡iva|
†ivM cieZx© gvby‡li g‡a¨ msµwgZ/gvbe Bbd¬z‡qÄv msµgb cÖwZ‡iva msµvš— M‡elbv evsjv‡`k (wemwUm)|
úªavb M†elK: Wvt w÷‡db wc. jzwŸ|
cÖwZôvbt Avš—©RvwZK D`ivgq M‡elYv †K›`ª, evsjv‡`k (AvBwmwWwWAvi,we)|
cÖv_wgK ‡ivMxi bvg t ÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑ
BDwbK AvB wWt ÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑ
M‡elYvi f~wgKvt
Avgiv Avgv‡`i M‡elbvq Ask MÖnY Kivi Rb¨ Avcbv‡K Avgš¿b Rvbvw”Q| evsjv‡`‡ki MÖvgv‡ji gvby‡li g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ †Kvb †Kvb welq `vqx †m m¤ú‡K© Rvbvi Rb¨ evsjv‡`‡ki Avš—©RvwZK D`ivgq M‡elYv †K›`ª (AvBwmwWwWAvi,we), hy³iv‡óªi †ivM wbqš¿b I cÖwZ‡iva †K›`ª Ges Av‡gwiKv‡Z Aew¯’Z GwU ev‡d‡jv BDwbfvwm©wU mw¤§wjZfv‡e GKwU M‡elbv Ki‡Q|
M‡elbvi D‡Ïk¨t
GKUv evwoi g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ wK wK welq RwoZ Avgiv Zv eyS‡Z †Póv KiwQ| Avgiv Av‡iv eyS‡Z ‡Póv KiwQ †h, mvevb w`‡q nvZ ay‡q Bbd¬z‡qÄv fvBivmRwbZ †iv‡Mi we¯—vi †iva Kiv m¤¢e wKbv| cÖvq 400 evwo‡K Avgiv Avgv‡`i M‡elbvq Aš—©f~³ Kie| Avgv‡`i j¶¨ _vK‡e mywbw`©ó wKQz AvPib Bbd¬z‡qÄv msµvg‡bi mv‡_ RwoZ wKbv Zv Ly‡Ru †ei Kiv|
Avcbv‡K †Kb GB M‡elYvq AskMÖn‡Yi Rb¨ Aby‡iva KiwQ?
GB M‡elYvq AskMÖn‡Yi Rb¨ Avcbv‡K Avgiv Aby‡iva KiwQ KviY MZ 7 w`‡bi g‡a¨ R¡‡ii mv‡_ mv‡_ Avcbvi Kvuwk/Mjve¨_v DcmM© j¶¨ Kiv †M‡Q| GB j¶b ¸‡jv Bbd¬z‡qÄv bvgK Amy¯’Zvi mv‡_ RwoZ _vK‡Z cv‡i | Avgiv GB Amy¯’ZvwU wb‡q M‡elbv Ki‡Z AvMÖnx|
‡ivMx / DËi`vZvi KvQ †_‡K Avgiv wK f~wgKv Avkv Kie?
‡KejgvÎ m¤¢ve¨ cÖv_wgK †ivMxi †¶‡Î cÖ‡hvR¨t
Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© Avcbvi bvK †_‡K bgybv msMÖn Ki‡e Ges Zv Bbd¬z‡qÄv fvBiv‡mi Rb¨ cix¶v Ki‡e| Avgiv Ge¨vcv‡i Avcbvi AbygwZ Kvgbv KiwQ|
wØZxqevi Avevi Avgiv Avcbvi bvK †_‡K Ges Mjv †_‡KI bgybv msMÖn Kie|AvgivGB bgybv¸‡jv †_‡K Bbd¬z‡qÄvi aib cix¶v K‡i ‡ei Ki‡ev, hv Avcbvi _vK‡Z cv‡i|
Avcwb ivwR _vK‡j Avgiv bgybvwU fwel¨‡Z cix¶v K‡i †`Lvi Rb¨ wek eQi msi¶b Kie Zvici Zv bó K‡i †djv n‡e| †mB cix¶v ¸‡jv n‡Z cv‡i Bbd¬z‡qÄv Qvov k¦vmZ‡š¿i Amy¯’Zvi Ab¨vb¨ Kvib Rvbvi Rb¨| fwel¨‡Z GB cix¶vi djvdj †Kvb fv‡e Avcbvi wPwKrmv‡K cÖfvweZ Ke‡e bv ZvB Avgiv Avcbv‡K †Kvb djvdjI cÖ`vb Kie bv| Avcwb msMÖwnZ bgybvwU †h †Kvb mgq msiw¶Z Ae¯’v †_‡K mwi‡q †dj‡Z ejvi Rb¨ †dvb Ki‡Z cv‡ib t Wvt w÷‡db wc. jzwŸ, 8860523-32 #2502|
‡KejgvÎ cieZx~‡Z AvµvšÍ †ivMx†`i †¶‡Î cÖ‡hvR¨t
Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© Avcbvi Mjv Ges bvK †_‡K bgybv msMÖn Ki‡e,Avwg G e¨vcv‡I Avcbvi AbygwZ cÖv_©bv KiwQ| GB bgybv mg~y‡n Bbd¬y‡qÄv Av‡Q wKbv Zv cix¶v K‡i †`Lv n‡e cieZx© mg‡q|
Avcwb ivwR _vK‡j Avgiv bgybvwU fwel¨‡Z cix¶v K‡i †`Lvi Rb¨ wek eQi msi¶b Kie Zvici Zv bó K‡i †djv n‡e| †mB cix¶v ¸‡jv n‡Z cv‡i Bbd¬z‡qÄv Qvov k¦vmZ‡š¿i Amy¯’Zvi Ab¨vb¨ Kvib Rvbvi Rb¨| fwel¨‡Z GB cix¶vi djvdj †Kvb fv‡e Avcbvi wPwKrmv‡K cÖfvweZ Ke‡e bv ZvB Avgiv Avcbv‡K †Kvb djvdjI cÖ`vb Kie bv| Avcwb msMÖwnZ bgybvwU †h †Kvb mgq msiw¶Z Ae¯’v †_‡K mwi‡q †dj‡Z ejvi Rb¨ †dvb Ki‡Z cv‡ib t Wvt w÷‡db wc. jzwŸ, 8860523-32 #2502|
SzwKu Ges myweav:
Avgiv Avcbvi Mjv I bvvK †_‡K gv_vq Zzjv c¨uvPv‡bv GKwU KvwVi mvnv‡h¨ wKQy bgybv msMÖn Kie| G‡Z Avcbvi wKQyUv A¯^w¯— n‡Z cv‡i; wKš‘ c×wZUv wbivc` Ges G‡Z Avcbvi †Kvb ¶wZi m¤¢vebv †bB| GB cix¶vwU Kivi Rb¨ Avcbvi †Kvb mywbw`©ó myweav †bB| †h‡nZz GB cix¶vi djvdj †Kvb fv‡e Avcbvi wPwKrmv‡K cÖfvweZ Ke‡e bv Avgiv Avcbv‡K †Kvb djvdjI cÖ`vb Kie bv| Z‡e Avcbvi KvQ †_‡K msMÖwnZ bgybv Avgv‡`i eyS‡Z mvnvh¨ Ki‡e wKfv‡e GKwU evoxi g‡a¨ Bbd¬z‡qÁv Qovq|
‡MvcbxqZv:
Avcbvi †`qv mKj Z_¨ ‡Mvcb ivLv n‡e| Avcbvi mg¯— Z_¨ I cix¶v- wbix¶vi djvdj dvBjeÜx K‡i ivLv n‡e| M‡elYvi Kv‡R mswkó bq Ggb KvD‡K Avgiv Avcbvi Z_¨ †`e bv| Avcbvi bvg KLbB M‡elbvi djvd‡j cÖKvwkZ n‡e bv|
fwel¨‡Z Z‡_¨i e¨envi t
Avgiv †h Z_¨ msMÖn Ki‡ev Zv fwel¨‡Z Ab¨ M‡elK e¨envi Ki‡Z Pvq Z‡e †Kvb e¨w³MZ Z_¨ Zv‡`i †`e bv G&es K‡Vvi fv‡e †MvcbxqZv i¶v Kie|
M‡elYvq AskMÖnb bv Kiv Ges cÖZ¨vnv‡ii AwaKvi:
Avcwb Avcbvi Mjv I bvvK †_‡K bgybv msMÖn Kivi AbygwZ w`‡Z cv‡ib Avevi bvI w`‡Z cv‡ib| Avcwb Avcbvi KvQ †_‡K bgybv msMÖn Kiv eÜ K‡i w`‡Z cv‡ib A_ev msMÖnK…Z bgybv cix¶v Kivi c~‡e© †d‡j w`‡ZI ej‡Z cv‡ib| Avcwb GB M‡elYvq AskMÖn‡b Am¤§Z n‡jI Gi Rb¨ Avcbv‡K †Kvb kvw¯Í ev Rwigvbv w`‡Z n‡e bv Ges nvmcvZv‡j cÖvc¨ myweav †_‡KI Avcwb ewÂZ n‡eb bv| GgbwK Avcwb Avgv‡`i‡K bgybv msMÖn Kivi AbygwZ bv w`‡jI nvmcvZvj †_‡K h_vh_ †mev cv‡eb| Avcwb wPwKrmv †mev A_ev Ab¨vb¨ my‡hvM-myweav †_‡K ewÂZ n‡eb bv|
¶wZc~iY ev cÖ‡`q:
bvK I Mjv †_‡K bgybv msMÖn Ki‡Z †`Iqvi Rb¨ Avcbvi †Kvb LiP †bB| GKBfv‡e Avcbv‡K †Kvb ¶wZc~ibI †`qv n‡e bv|
‡hvMv‡hvMi e¨vw³t
GB cÖwµqv PjvKvjxb Avcbvi †Kvb cÖkœ _vK‡j †h †Kvb mgq Ki‡Z cv‡ib| hw` Avcbvi M‡elbv m¤ú‡K© †Kvb AwZwi³ cÖkœ _v‡K Avcwb †hvMv‡hvM Ki‡Z cv‡ib t
Wvt w÷‡db wc. jzwŸ, †cÖvMÖvg Ab Bb‡dKkvm wWwRR G¨vÛ †fKwmb mvB‡Ým (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, †dvb t 8860523-32 # 2502|
GB M‡elbv Ask wnmv‡e Avcbvi AwaKvi m¤ú‡K© hw` Avcbvi †Kvb cÖkœ _v‡K A_ev hw` M‡elbvi Rb¨ Avcbvi †Kvb ¶wZ n‡q‡Q e‡j g‡b nq Zvn‡j †hvMv‡hvM Ki“b t
wgt Gg.G.mvjvg, wimvP© G¨Û cÖ‡R± mv‡cv©U wWcvU©‡g›U (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv– 1212, †dvb t 9886489, # 01711428989|
hw` Avcwb/Avcbvi †ivMx hw` Avgv‡`i bvK I Mjv †_‡K bgybv msMÖ‡ni cÖ¯Ív‡e ivwR _v‡Kvb Zvn‡j AbyMÖn K‡i i Avcbvi ¯^v¶i w`‡q A_ev Avcbvi evg nv‡Zi ey‡ov Av½y‡ji Qvc w`‡q Zv wb‡`©k Ki“b|
Avcbvi mn‡hvMxZvi Rb¨ ab¨ev`|
___________________________________________
¯^v¶i/ AskMÖnbKvixi evg nv‡Zi e„Øv½yjxi Qvc ZvwiL
___________________________________________
¯^v¶xi ¯^v¶vi / A_ev evg nv‡Zi e„Øv½yjxi Qvc ZvwiL
___________________________________________
cÖavb M‡elK ev Zvi cÖwZwbwai ¯^v¶i ZvwiL
cwiwkó-3t wcZv gvZv A_ev AwffveK‡`i m¤§wZcÎt bgybv msMÖn
M‡elYv b¤^i: 2009-004
M‡elbvi bvgt mvevb w`‡q nvZ †avqvi gva¨‡g †ivM ciewZ© Bbd¬z‡qÄv msµgb cÖwZ‡iva|
†ivM cieZx© Bbd¬z‡qÄv msµgb cÖwZ‡iva msµvš— M‡elbv evsjv‡`k (wemwUm)|
úªavb M†elK: Wvt w÷‡db wc. jzwŸ|
cÖwZôvbt Avš—©RvwZK D`ivgq M‡elYv †K›`ª, evsjv‡`k (AvBwmwWwWAvi,we)|
cÖv_wgK ‡ivMxi bvg t ÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑ
BDwbK AvB wWt ÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑÑ
M‡elYvi f~wgKvt
Avgiv Avgv‡`i M‡elbvq Ask MÖnY Kivi Rb¨ Avcbvi wkï‡K Avgš¿b Rvbvw”Q| evsjv‡`‡ki MÖvgv‡ji gvby‡li g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ †Kvb †Kvb welq `vqx †m m¤ú‡K© Rvbvi Rb¨ evsjv‡`‡ki Avš—©RvwZK D`ivgq M‡elYv †K›`ª (AvBwmwWwWAvi,we), hy³iv‡óªi †ivM wbqš¿b I cÖwZ‡iva †K›`ª Ges ev‡d‡jv BDwbfvwm©wUi M‡elKiv wg‡j mw¤§wjZfv‡e GKwU M‡elbv Ki‡Q|
M‡elbvi D‡Ïk¨t
GKUv evwoi g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ wK wK welq RwoZ Avgiv Zv eyS‡Z †Póv KiwQ| Avgiv Av‡iv eyS‡Z ‡Póv KiwQ †h, mvevb w`‡q nvZ ay‡q Bbd¬z‡qÄv fvBivmRwbZ †iv‡Mi we¯—vi †iva Kiv m¤¢e wKbv| cÖvq 200 evwo‡K Avgiv Avgv‡`i M‡elbvq Aš—f~©³ Kie| Bbd¬z‡qÄv we¯—v‡ii mv‡_ wbw`©ó †Kvb AvPib RwoZ wKbv Zv Lyu‡R †ei Kivi j‡¶¨ Avgiv KvR Kie|
‡Kb g‡bvwbZ Kiv n‡q‡Q ?
GB M‡elYvq AskMÖn‡Yi Rb¨ Avcbvi wkï‡K Avgiv Aby‡iva KiwQ Kvib MZ 7 w`‡bi g‡a¨ R¡‡ii mv‡_ mv‡_ Zvi Kvwk/Mjve¨_v DcmM© j¶¨ Kiv †M‡Q| Zvi G mKj DcmM© Bbd¬z‡qÄv bvgK Amy¯’Zvi mv‡_ m¤úwK©Z Avgiv GB Amy¯’ZvwU wb‡q M‡elbv Ki‡Z AvMÖnx|
‡ivMx / DËi`vZvi KvQ †_‡K Avgiv wK f~wgKv Avkv Kie ?
‡KejgvÎ m¤¢ve¨ cÖv_wgK †ivMxi †¶‡Î cÖ‡hvR¨t
Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© Avcbvi wkïi bvK †_‡K bgybv msMÖn Ki‡e Ges Zv Bbd¬z‡qÄv fvBiv‡mi Rb¨ cix¶v Ki‡e| Avgiv G e¨vcv‡i Avcbvi AbygwZ Kvgbv KiwQ|
Avgiv wØZxqevi Avevi I Zvi bvK I Mjv †_‡K bgybv msMÖn Kie| Avcbvi wkï wK ai‡bi Bbd¬y‡qÄv Øviv AvµvšÍ n‡q _vK‡Z cv‡i Zv GB bgybv w`‡q cix¶v Kiv n‡e|
Avcwb ivwR _vK‡j Avgiv bgybvwU fwel¨‡Z cix¶v K‡i †`Lvi Rb¨ wek eQi msi¶b Kie Zvici Zv bó K‡i †djv n‡e| †mB cix¶v ¸‡jv n‡Z cv‡i Bbd¬z‡qÄv Qvov k¦vmZ‡š¿i Amy¯’Zvi Ab¨vb¨ Kvib Rvbvi Rb¨| fwel¨‡Z GB cix¶vi djvdj †Kvb fv‡e Avcbvi wkïi wPwKrmv‡K cÖfvweZ Ke‡e bv ZvB Avgiv Avcbv‡K †Kvb djvdjI cÖ`vb Kie bv| Avcwb msMÖwnZ bgybvwU †h †Kvb mgq msiw¶Z Ae¯’v †_‡K mwi‡q †dj‡Z ejvi Rb¨ †dvb Ki‡Z cv‡ib t Wvt w÷‡db wc. jzwŸ, 860523-32 #2502|
‡KejgvÎ cieZx©‡Z AvµvšÍ †ivMx†`i †¶‡Î cÖ‡hvR¨t
Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© Avcbvi wkïi bvK I Mjv †_‡K bgybv msMÖn Ki‡e,Avwg G e¨vcv‡iI Avcbvi AbygwZ cÖv_©bv KiwQ| GB bgybv mg~y‡n Bbd¬y‡qÄv Av‡Q wKbv Zv cix¶v K‡i †`Lv n‡e|
Avcwb ivwR _vK‡j Avgiv bgybvwU fwel¨‡Z cix¶v K‡i †`Lvi Rb¨ wek eQi msi¶b Kie Zvici Zv bó K‡i †djv n‡e| †mB cix¶v ¸‡jv n‡Z cv‡i Bbd¬z‡qÄv Qvov k¦vmZ‡š¿i Amy¯’Zvi Ab¨vb¨ Kvib Rvbvi Rb¨| fwel¨‡Z GB cix¶vi djvdj †Kvb fv‡e Avcbvi wkïi wPwKrmv‡K cÖfvweZ Ke‡e bv ZvB Avgiv Avcbv‡K †Kvb djvdjI cÖ`vb Kie bv| Avcwb msMÖwnZ bgybvwU †h †Kvb mgq msiw¶Z Ae¯’v †_‡K mwi‡q †dj‡Z ejvi Rb¨ †dvb Ki‡Z cv‡ib t Wvt GWyqv©Wy AvwRR †evgMvU©bvi | 8860523-32 #2500|
SzwKu Ges myweav:
Avgiv Avcbvi Mjv I bvvK †_‡K gv_vq Zzjv c¨uvPv‡bv GKwU KvwVi mvnv‡h¨ wKQy bgybv msMÖn Kie| G‡Z Avcbvi wKQyUv A¯^w¯— n‡Z cv‡i; wKš‘ c×wZUv wbivc` Ges G‡Z Avcbvi †Kvb ¶wZi m¤¢vebv †bB| GB cix¶vwU Kivi Rb¨ Avcbvi †Kvb mywbw`©ó myweav †bB| †h‡nZz GB cix¶vi djvdj †Kvb fv‡e Avcbvi wPwKrmv‡K cÖfvweZ Ke‡e bv Avgiv Avcbv‡K †Kvb djvdjI cÖ`vb Kie bv| Z‡e Avcbvi KvQ †_‡K msMÖwnZ bgybv Avgv‡`i eyS‡Z mvnvh¨ Ki‡e wKfv‡e GKwU evoxi g‡a¨ Bbd¬z‡qÁv Qovq|
‡MvcbxqZv:
Avcbvi wkïi/Avcbvi mKj Z_¨ hv Avgiv msMÖn K‡iwQ Zv †Mvcb ivLv n‡e| mg¯— Z_¨ I cix¶v- wbix¶vi djvdj dvBjeÜx K‡i ivLv n‡e| M‡elYvi mv‡_ RwoZ bq Ggb KvD‡K Avcbvi wkïi †Kvb Z_¨ †`Iqv n‡e bv| M‡elYv welqK †Kvb Av‡jvPbvq wKsev M‡elbvi dj cÖKv‡ki mgq Avcbvi wkïi bvg KL‡bv e¨eüZ n‡e bv|
Z_¨mg~‡ni fwel¨Z e¨envi:
hw` Avgv‡`i msMªwnZ Z_¨ fwel¨‡Z Ab¨ M‡elK†`i cª‡qvRb nq Zvn‡j Avgiv Avcbv‡`i †Kvb e¨vw³MZ Z_¨ Zv‡`i‡K †`e bv Ges KwVb †MvcbxqZv i¶v Kie|
M‡elYvq AskMÖnb bv Kiv Ges cÖZ¨vnv‡ii AwaKvi:
Avcwb Avcbvi wkïi Mjv I bvK †_‡K bgybv msMÖn Kivi AbygwZ w`‡Z cv‡ib Avevi bvI w`‡Z cv‡ib| Avcwb Avcbvi wkïi KvQ †_‡K bgybv msMÖn Kiv eÜ K‡i w`‡Z cv‡ib A_ev msMÖnK…Z bgybv cix¶v Kivi c~‡e© †d‡j w`‡ZI ej‡Z cv‡ib| Avcwb Avcbvi wkï‡K GB M‡elYvq AskMÖnb Ki‡Z w`‡Z Am¤§Z n‡jI Gi Rb¨ Avcbv‡K †Kvb kvw¯Í ev Rwigvbv w`‡Z n‡e bv Ges nvmcvZv‡j cÖvc¨ myweav †_‡KI Avcbvi wkï ewÂZ n‡e bv| GgbwK Avcwb Avgv‡`i‡K bgybv msMÖn Kivi AbygwZ bv w`‡jI Avcbvi wkï nvmcvZvj †_‡K h_vh_ †mev cv‡e| †m wPwKrmv †mev A_ev Ab¨vb¨ my‡hvM-myweav †_‡K ewÂZ n‡e bv|
¶wZc~iY ev cÖ‡`q:
bvK I Mjv †_‡K bgybv msMÖn Ki‡Z †`Iqvi Rb¨ Avcbv‡K/ Avcbvi wkïi †Kvb LiP †bB| GKBfv‡e Avcbv‡K ev Avcbvi wkï‡K I †Kvb ¶wZc~ib †`qv n‡e bv|
‡hvMv‡hvMi e¨vw³t
GB cÖwµqv PjvKvjxb Avcbvi †Kvb cÖkœ _vK‡j †h †Kvb mgq Ki‡Z cv‡ib| hw` Avcbvi M‡elbv m¤ú‡K© †Kvb AwZwi³ cÖkœ _v‡K Avcwb †hvMv‡hvM Ki‡Z cv‡ib t
Wvt w÷‡db wc. jzwŸ, †cÖvMÖvg Ab Bb‡dKkvm wWwRR G¨vÛ †fKwmb mvB‡Ým (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, †dvb t 8860523-32 # 2502|
GB M‡elbv Ask wnmv‡e Avcbvi AwaKvi m¤ú‡K© hw` Avcbvi †Kvb cÖkœ _v‡K A_ev hw` M‡elbvi Rb¨ Avcbvi †Kvb ¶wZ n‡q‡Q e‡j g‡b nq Zvn‡j †hvMv‡hvM Ki“b t
wgt Gg.G.mvjvg, wimvP© G¨Û cÖ‡R± mv‡cv©U wWcvU©‡g›U (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv– 1212, †dvb t 9886489, # 01711428989|
hw` Avcwb/Avcbvi †ivMx hw` Avgv‡`i bvK I Mjv †_‡K bgybv msMÖ‡ni cÖ¯Ív‡e ivwR _v‡Kvb Zvn‡j AbyMÖn K‡i i Avcbvi ¯^v¶i w`‡q A_ev Avcbvi evg nv‡Zi ey‡ov Av½y‡ji Qvc w`‡q Zv wb‡`©k Ki“b|
Avcbvi mn‡hvMxZvi Rb¨ ab¨ev`|
_______________________________________
ïkªlvKvix / AwffveK Gi evg nv‡Zi e„Øv½yjxi Qvc ZvwiL
___________________________________________
¯^v¶xi ¯^v¶vi / A_ev evg nv‡Zi e„Øv½yjxi Qvc ZvwiL
___________________________________________
cÖavb M‡elK ev Zvi cÖwZwbwai ¯^v¶i ZvwiL
cwiwkó-4t wkï‡`i m¤§wZcÎt bgybv msMÖn
M‡elYv b¤^i: 2009-004
M‡elbvi bvgt mvevb w`‡q nvZ †avqvi gva¨‡g †ivM ciewZ© Bbd¬z‡qÄv msµgb cÖwZ‡iva|
†ivM cieZx© Bbd¬z‡qÄv msµgb cÖwZ‡iva msµvš— M‡elbv evsjv‡`k (wemwUm)|
úªavb M†elK: Wvt w÷‡db wc. jzwŸ|
cÖwZôvbt Avš—©RvwZK D`ivgq M‡elYv †K›`ª, evsjv‡`k (AvBwmwWwWAvi,we)|
Avgiv Kviv?
Avgvi bvg_______________ Ges Avwg KvR Kwi_______________
Avgiv †Kb ‡Zvgvi mv‡_ mv¶vr KiwQ?
‡hme †jv‡Ki wbw`©ó wKQy DcmM© t Kvwk I/ A_ev Mjve¨_v Ges R¡i †`Lv hvq Avgiv Zv‡`i wb‡q GKwU M‡elYv cwiPvjbv KiwQ| GmKj DcmM© Bbd¬z‡qÄv bvgK Amy¯’Zvi mv‡_ m¤úwK©Z Avgiv GB Amy¯’ZvwU wb‡q M‡elbv Ki‡Z AvMÖnx|
Avgiv †Kb GB M‡elYv Kg©wU cwiPvjbv KiwQ?
GKUv evwoi g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ wK wK welq RwoZ Avgiv Zv eyS‡Z †Póv KiwQ| Bbd¬z‡qÄv
we¯—v‡ii mv‡_ wbw`©ó †Kvb AvPib RwoZ wKbv Avgiv Zv Rvb‡Z PvB|
GB M‡elYvq _vK‡j †Zvgvi wK n‡e?
ïaygvÎ m¤¢ve¨ cÖv_wgK †ivMxi †¶‡Î-
GKRb cÖwkw¶Z M‡elbvKgx© †Zvgvi bvK †_‡K bgybv msMÖn Ki‡e|Avwg †m e¨vcv‡i †Zvgvi AbygwZ Pvw”Q| GB bgybvwU Bbd¬z‡qÄv fvBivm Gi Rb¨ cix¶v Kie|
wØZxqevi AveviI †Zvgvi bvK Ges Mjv †_‡KI bgybv msMÖn Kie|Avgiv GB bgybv ¸‡jv †_‡K †Zvgvi wK ai‡bi Bbd¬z‡qÄv n‡q _vK‡Z cv‡i Zv cix¶v K‡i †`L‡ev|
Zzwg ivwR _vK‡j Avgiv bgybvwU fwel¨‡Z cix¶v K‡i †`Lvi Rb¨ wek eQi msi¶b Kie Zvici Zv bó K‡i †djv n‡e| Avgiv cieZx©‡Z GB bgybv¸‡jv Bbd¬z‡qÄv Qvov k¦vmZ‡š¿i Ab¨vb¨ Amy¯’Zv Rvbvi Rb¨ cix¶v Kie | fwel¨‡Z GB cix¶vi djvdj †Kvb fv‡e †Zvgvi wPwKrmv‡K cÖfvweZ Ke‡e bv ZvB Avgiv †Zvgv‡K †Kvb djvdjI cÖ`vb Kie bv| Zywg msMÖwnZ bgybvwU †h †Kvb mgq msiw¶Z Ae¯’v †_‡K mwi‡q †dj‡Z ejvi Rb¨ †dvb Ki‡Z cvi t
Wvt w÷‡db wc. jzwŸ, 8860523-32 #2502|
‡KejgvÎ cieZx©‡Z AvµvšZ †ivMxi †¶‡Î cÖ‡hvh¨:
Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© †Zvgvi Mjv Ges bvK †_‡K bgybv msMÖn Ki‡e| Avwg †m e¨vcv‡i †Zvgvi AbygwZ Pvw”Q| GB bgybv mgy‡n Bbd¬z‡qÄv fvBivm Av‡Q wKbv Zv cix¶v K‡i †`Le|
Zzwg ivwR _vK‡j Avgiv bgybvwU fwel¨‡Z cix¶v K‡i †`Lvi Rb¨ wek eQi msi¶b Kie Zvici Zv bó K‡i †djv n‡e| †mB cix¶v ¸‡jv n‡Z cv‡i Bbd¬z‡qÄv Qvov k¦vmZ‡š¿i Amy¯’Zvi Ab¨vb¨ Kvib Rvbvi Rb¨| fwel¨‡Z GB cix¶vi djvdj †Kvb fv‡e †Zvgvi wPwKrmv‡K cÖfvweZ Ke‡e bv ZvB Avgiv †Zvgv‡K †Kvb djvdjI cÖ`vb Kie bv| Zywg msMÖwnZ bgybvwU †h †Kvb mgq msiw¶Z Ae¯’v †_‡K mwi‡q †dj‡Z ejvi Rb¨ †dvb Ki‡Z cvi t
Wvt w÷‡db wc. jzwŸ, 8860523-32 #2502|
fvj ev Lvivc wRwbm¸‡jv wK hv †Zvgvi n‡Z cv‡i?
Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© †Zvgvi Mjv Ges bvK †_‡K gv_vq Zzjv c¨uvPv‡bv GKwU KvwVi mvnv‡h¨ wKQy bgybv msMÖn Ki‡e| G‡Z †Zvgvi wKQyUv A¯^w¯— n‡Z cv‡i; wKš‘ Zzwg e¨v_v cv‡e bv|
Zzwg wK Avgv‡`i‡K bgybv msMÖn Ki‡Z w`‡Z ivRx?
bv , Zzwg bgybv msMÖn Ki‡Z w`‡Z ivRx bv| Zzwg bgybv msMÖn Ki‡Z w`‡Z bv PvB‡j †KD ‡Zvgvi cÖwZ gb Lvivc Ki‡e bv ev ivMvwš^Z n‡e bv| AskMÖnY Ki‡Z bv PvB‡j Avgv‡`i‡K ej‡Z cv‡iv| g‡b ‡i‡Lv, Zzwg PvB‡j
c‡iI gZ e`jv‡Z cv‡iv hw` Zzwg wmavšÍ wb‡q _vK †h Avi M‡elYvq AskMÖnY Ki‡e bv|
†Zvgvi wK †Kvb cÖkœ Av‡Qt
Zzwg Zv wbwשavq †h‡Kvb mgq cÖkœ Ki†Z cv‡ib| Zzwg Zv GLb A_ev c‡iI wR‡Ám Ki‡Z cv‡iv| M‡elYv PjvKv‡j Zzwg Avgvi mv‡_ A_ev Ab¨ Kv‡iv mv‡_ K_v ej‡Z cv‡iv| †Zvgvi Av‡iv wKQy Rvbvi _vK‡j Zzwg wbæwjwLZ e¨w³i mv‡_ †hvMv‡hvM Ki‡Z cv‡ivt
Wvt w÷‡db wc. jzwŸ, †cÖvMÖvg Ab Bb‡dKkvm wWwRR G¨vÛ †fKwmb mvB‡Ým (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, †dvb t 8860523-32 # 2502|
GB M‡elbv Ask wnmv‡e Avcbvi AwaKvi m¤ú‡K© hw` Avcbvi †Kvb cÖkœ _v‡K A_ev hw` M‡elbvi Rb¨ Avcbvi †Kvb ¶wZ n‡q‡Q e‡j g‡b nq Zvn‡j †hvMv‡hvM Ki“b t
wgt Gg.G.mvjvg, wimvP© G¨Û cÖ‡R± mv‡cv©U wWcvU©‡g›U (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv– 1212, †dvb t 9886489, # 01711428989|
Zzwg hw` M‡elYvq Ask wb‡Z Ges bgybv msMÖn Ki‡Z w`‡Z ivRx _v‡Kv, Zvn‡j AbyMÖn K‡i bx‡P ‡Zvgvi ¯^v¶i A_ev evg nv‡Zi e„×v½ywji Qvc `vI:
‡Zvgvi mn‡hvwMZvi Rb¨ ab¨ev`|
__________________________________ ____________________
AskMÖnYKvixi ¯^v¶i/evg nv‡Zi e„×v½yjxi Qvc ZvwiL
__________________________________ ____________________
Awffve‡Ki ¯^v¶i/evg nv‡Zi e„×v½yjxi Qvc ZvwiL
__________________________________ ____________________
mv¶xi ¯^v¶i/evg nv‡Zi e„×v½yjxi Qvc ZvwiL
__________________________________ ___________________
M‡elK/cÖwZwbwai ¯^v¶i ZvwiL
cwiwkó-5t m¤§wZcÎt M‡elbv ZvwjKvf~w³Kib, Lvbv/ evwo
M‡elYv b¤^i: 2009-004
M‡elbvi bvgt mvevb w`‡q nvZ †avqvi gva¨‡g †ivM ciewZ© Bbd¬z‡qÄv msµgb cÖwZ‡iva|
†ivM cieZx© Bbd¬z‡qÄv msµgb cÖwZ‡iva msµvš— M‡elbv evsjv‡`k (wemwUm)|
úªavb M†elK: Wvt w÷‡db wc. jzwŸ|
cÖwZôvbt Avš—©RvwZK D`ivgq M‡elYv †K›`ª, evsjv‡`k (AvBwmwWwWAvi,we)|
M‡elYvi f~wgKvt
Avgiv Avgv‡`i M‡elbvq Ask MÖnY Kivi Rb¨ Avcbvi evwo‡K Avgš¿b Rvbvw”Q| evsjv‡`‡ki MÖvgv‡ji gvby‡li g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ †Kvb †Kvb welq `vqx †m m¤ú‡K© Rvbvi Rb¨ evsjv‡`‡ki Avš—©RvwZK D`ivgq M‡elYv †K›`ª (AvBwmwWwWAvi,we), hy³iv‡óªi †ivM wbqš¿b I cÖwZ‡iva †K›`ª Ges ev‡d‡jv BDwbfvwm©wUi M‡elKiv wg‡j mw¤§wjZfv‡e GKwU M‡elbv Ki‡Q|
M‡elbvi D‡Ïk¨t
GKUv evwoi g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ wK wK welq RwoZ Avgiv Zv eyS‡Z †Póv KiwQ| Avgiv Av‡iv eyS‡Z ‡Póv KiwQ †h, mvevb w`‡q nvZ ay‡q Bbd¬z‡qÄv fvBivmRwbZ †iv‡Mi we¯—vi †iva Kiv m¤¢e wKbv| cÖvq 400 evwo‡K Avgiv Avgv‡`i M‡elbvq Aš—©f~³ Kie| Avgv‡`i j¶¨ _vK‡e mywbw`©ó wKQz AvPib Bbd¬z‡qÄv msµvg‡bi mv‡_ RwoZ wKbv Zv Ly‡Ru †ei Kiv|
Avcbvi evwo‡K †Kb GB M‡elYvq AšÍ©f~³ Kiv n‡q‡Q?
Avcbvi evwoi GKRb m`‡m¨i g‡a¨ Bbd¬z‡qÄv †iv‡Mi j¶Y/DcmM© cvIqv †M‡Q| ZvB Avcbvi evwo‡K Avgv‡`i‡K mn‡hvwMZv Kivi Rb¨ Aby‡iva KiwQ|
Avcbvi evwoi m`‡m¨i Kv‡Q Avgiv wK cÖZ¨vkv Kie?
Avcwb hw` Avcbvi evwo‡K GB M‡elYvq AšÍ©f~³ Ki‡Z Pvbt
Avwg cÖwZwU Lvbvi mKj m`m¨‡K wPwýZ Kie|
Avgiv Avcbvi evwoi wewfbœ w`K ch©‡e¶b Kie hv wKbv Bbd¬z‡qÄv †iv‡Mi j¶Y Qov‡bvi mv‡_ RwoZ _vK‡Z cv‡i| Avgiv evwoi cÖwZwU Lvbv m¤ú‡K© cÖkœ wR‡Ám Kie Ges H Lvbvi kvixwiK ˆewkó¨mg~n ch©‡e¶b Kie|
Bbd¬z‡qÄv AvµvšÍ e¨w³i j¶bmgyn K‡g hvIqvi w`b †_‡K Av‡iv 10 w`b cÖwZw`b Avgiv Avcbvi evwo cwi`k©b Ki‡ev| GB w`b¸‡jv‡Z Avgiv Avcbvi evwoi Ab¨ †Kvb e¨w³i g‡a¨ Bbd¬z‡qÄvi DcmM© †`Lv w`‡q‡Q wKbv Zv wR‡Ám Ki‡ev|
Avgv‡`i GB cwi`k©‡bi mgq hw` evwoi †Kvb m`‡m¨i g‡a¨ Bbd¬z‡qÄv †iv‡Mi j¶Y/DcmM© j¶¨ Kiv hvq, Zvn‡j Avgiv Zv‡K Zvi bvK I Mjv †_‡K bgybv msMÖn Kivi AbygwZ w`‡Z Aby‡iva Rvbve| GB bgybv Bbd¬z‡qÄv fvBiv‡mi Rb¨ cix¶v Ki‡e|
GB M‡elYvwU GKwU ga¨eZx© cix¶b c×wZ| Zvi gv‡b wKQy evwo‡Z KZK¸‡jv bZzb AvPib wkLv‡bv n‡e Ges mvevb †`Iqv n‡e evwo cwi`k©‡bi mgq | Avi evwK evwo¸‡jv‡Z mvevb †`Iqv n‡e Avgv‡`i cÖwZw`‡bi evox cwi`k©b KvR †kl Kivi c‡i evwK evwo¸‡jv‡Z fwel¨‡Z AvPib ¸‡jv wkLv‡bv n‡e| ‡hme evwo‡Z bZzb AvPib wkLv‡bv n‡e Ges mvevb †`Iqv n‡e ‡mB evwo¸‡jv ‰`e Pq‡bi wfwˇZ (jUvix) `‡j wef³ Kiv n‡e| ZvB †Kvb evwo¸‡jv‡Z bZzb AvPib wkLv‡bv n‡e Ges mvevb †`Iqv n‡e ‡mUv Avgv‡`i wbqš¿‡bi evB‡i|
SzwKu Ges myweav:
evRv‡i cvIqv mvevb e¨env‡i hv‡`i Pvgovq cvk¦©- cÖwZwµqv †`Lv †`q, Avgv‡`i ‡`Iqv mvevb e¨env‡iI Zv‡`i GKB ai‡bi cvk¦©- cÖwZwµqv †`Lv w`‡Z cv‡i| Gai‡bi †jvKR‡bi Avgv‡`i †`Iqv mvevb e¨envi Kiv DwPZ bq|Avcbvi cwiev‡i Kv‡iv cwi`k©‡bi welqwU Avcbv‡`i Rb¨ wKQyUv A¯^w¯Í`vqK n‡Z cv‡i| Z‡e Avcbvi cwiev‡i cwi`k©‡bi d‡j Avcwb ev Avcbvi cwievi †Kvb ai‡bi ¶wZi m¤§yLxb n‡eb bv e‡j Avkv Kwi|
GB M‡elYvq AšÍ©f~³ cÖwZwU evwo bZzb AvPib wkLvi I mvevb cvIqvi myweav jvf Ki‡e| GQvov Zvr¶wbK Avi †Kvb myweav cv‡eb bv| GKUv Lvbvi g‡a¨ Bbd¬z‡qÄv fvBivm Qov‡bvi Rb¨ wK wK welq RwoZ GB M‡elYv Avgv‡`i‡K †m m¤ú‡K© Av‡iv fvjfv‡e eyS‡Z mvnvh¨ Ki‡e| GB M‡elYv Avgv‡`i‡K Bbd¬z‡qÄv †iv‡Mi j¶Y /DcmM© we¯Ívi †iva Kivi †KŠkj cix¶v Ki‡Z mvnvh¨ Ki‡e| evsjv‡`‡ki MÖvgv‡ji cwiev‡ii g‡a¨ Bbd¬z‡qÄv †iv‡Mi j¶Y/DcmM© we¯Ívi wKfv‡e †iva Kiv hvq GB M‡elYv Zv eyS‡ZI mnvqZv Ki‡Z cv‡i|
‡hme †jv‡Ki g‡a¨ Bbd¬z‡qÄv fvBiv‡mi DcmM© †`Lv hv‡e Ges hviv Zv‡`i Mjv Ges bvK †_‡K bgybv msMÖn Ki‡Z w`‡Z m¤§Z n‡e Avgv‡`i GKRb cÖwkw¶Z M‡elbvKgx© Zv‡`i Mjv Ges bv‡K GKwU Zzjv †`qv KvwV w`‡q bgybv msMÖn Ki‡e| GUv Zv‡`i Rb¨ wKQyUv A¯^w¯—`vqK n‡Z cv‡i|Rvbv g‡Z GQvov G‡Z Avi †Kvb ¶wZi m¤¢vebv †bB|
bgybv msMÖ‡ni ci GK gvm ev K‡qK gv‡mi Rb¨ Bbd¬z‡qÄv cix¶vi djvdj Rvbv hv‡e bv| Bbd¬z‡qÄv cix¶vi GB djvdj †Kvbfv‡eB AvµvšÍ e¨w³i wPwKrmvq †Kvb cÖfve ‡dj‡e bv|
‡MvcbxqZv:
Avcbvi mgv‡Ri mKj m`m¨m¤ú‡K© msM„nxZ mKj Z_¨ †Mvcb ivLv n‡e| mKj Z_¨ GKwU Zvjve× Avjgvix‡Z dvBjeÜx K‡i ivLv n‡e| M‡elYvi mv‡_ mswkó bq Ggb KvD‡K Avgiv Avcbvi mgv‡Ri †Kvb Z_¨ mieivn Kie bv|
fwerl¨‡Z Z_¨¸‡jvi e¨envi: fwerl¨‡Z hw` Z_¨¸‡jv Ab¨ M‡el‡Ki cÖ‡qvR‡b e¨envi Kiv nq,Z‡e Avgiv Avcbvi †Kvb e¨w³MZ Z_¨ Zv‡`I mieivn Ki‡ev bv| Avgiv K‡Vvi †MvcbxqZv i¶v Ki†ev|
M‡elYvq AskMÖnb bv Kiv Ges cÖZ¨vnv‡ii AwaKvi:
Avcwb Avcbvi evwowU‡K GB M‡elYvq AšÍ©f~³ Ki‡Z m¤§Z n‡Z cv‡ib Avevi bvI cv‡ib| M‡elYv PjvKvjxb †h‡Kvb mg‡q Avcwb AskMÖnY Ki‡Z Am¤§ZI n‡Z cv‡ib| †h‡Kvb mgq Avcwb Avcbvi evwo‡K M‡elYv †_‡K cÖZ¨vnvi K‡i wb‡Z cv‡ib| M‡elYvq AskMÖnY Ki‡Z Am¤§wZ A_ev M‡elYv †_‡K bvg cÖZ¨vnv‡ii d‡j Avcbvi KwgDwbwUi †Kvb m`m¨‡K †Kvb kvw¯Í cÖ`vb Kiv n‡e bv Ges wK¬wbK ev nvmcvZv‡ji cÖvc¨ wPwKrmv †mev †_‡KI ewÂZ n‡eb bv| GgbwK Avcwb hw` Avcbvi evwo‡K GB M‡elYvq AšÍ©f~³ bvI K‡ib, ZeyI Avcbvi evwoi cÖwZwU m`m¨ wK¬wbK ev nvmcvZvj †_‡K h_vh_ ¯^v¯’¨‡mev cv‡e| Avcbvi evwoi cÖwZwU m`m¨ e¨w³MZfv‡eI GB M‡elYvq AskMÖnb Ki‡Z cv‡ib Avevi bvI cv‡ib| GgbwK M‡elYv PjvKvjxb †h‡Kvb mg‡q M‡elYv †_‡K wb‡R‡K cÖZ¨vnvi K‡i wb‡Z cv‡ib|
¶wZc~iY bxwZ t
GB M‡elYvq AskMÖn‡bi Rb¨ Avcbv‡K A_ev Avcbvi evwo‡K †Kvb A_© cÖ`vb Ki‡Z n‡e bv| GKBfv‡e webv g~‡j¨ mvevb cvIqv Qvov GB M‡elYvq AskMÖn†bi Rb¨ Avi wKQy cv‡eb bv|
‡hvMv‡hvMi e¨vw³t
GB cÖwµqv PjvKvjxb Avcbvi †Kvb cÖkœ _vK‡j †h †Kvb mgq Ki‡Z cv‡ib| hw` Avcbvi M‡elbv m¤ú‡K© †Kvb AwZwi³ cÖkœ _v‡K Avcwb †hvMv‡hvM Ki‡Z cv‡ib t
Wvt w÷‡db wc. jzwŸ, †cÖvMÖvg Ab Bb‡dKkvm wWwRR G¨vÛ †fKwmb mvB‡Ým (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, †dvb t 8860523-32 # 2502|
GB M‡elbv Ask wnmv‡e Avcbvi AwaKvi m¤ú‡K© hw` Avcbvi †Kvb cÖkœ _v‡K A_ev hw` M‡elbvi Rb¨ Avcbvi †Kvb ¶wZ n‡q‡Q e‡j g‡b nq Zvn‡j †hvMv‡hvM Ki“b t
wgt Gg.G.mvjvg, wimvP© G¨Û cÖ‡R± mv‡cv©U wWcvU©‡g›U (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv– 1212, †dvb t 9886489, # 01711428989|
Avcwb hw` GB M‡elYvq Avcbvi evwo‡K AšÍ©f~³ Ki‡Z m¤§Z _v‡Kb, Zvn‡j AbyMÖn K‡i bx‡P Avcbvi ¯^v¶i A_ev evg nv‡Zi e„×v½ywji Qvc w`b:
Avcbvi mn‡hvwMZvi Rb¨ ab¨ev`|
__________________________________ ____________________
AskMÖnYKvixi ¯^v¶i/evg nv‡Zi e„×v½yjxi Qvc ZvwiL
__________________________________ ____________________
mv¶xi ¯^v¶i/evg nv‡Zi e„×v½yjxi Qvc ZvwiL
__________________________________ ___________________
M‡elK/cÖwZwbwai ¯^v¶i ZvwiL
Appendix 6: evwo Dchy³Zv hvPvB dg© Bari Eligibility Form VERSION 16.06.10
INDEX CASE ID: ______________________ FRA CODE: _____________________
|1. wRÁvmv Ki“b: আইসিপি ছাড়া আইসিপি Lvbvi †Kv‡bv m`m¨wK MZ 7 w`‡bi g‡a¨ R¡‡i f~‡M‡Q? |( |
|1. ASK: Apart from the ICP, have any of the residents of the ICP household had a fever in the past 7 | |
|days? | |
|Yes (1) No (2) | |
|(ÓnvÓ n‡j evwo Dchy³ bq) (If ‘yes,’ this bari is ineligible) | |
|1b. wRÁvmv Ki“b: আইসিপি Lvbv ছাড়া Avcbvi evwoi †Kv‡bv m`m¨wK MZ 7 w`‡bi g‡a¨ R¡‡i f~‡M‡Q? |( |
|1b. ASK: Apart from the ICP household, have any of the residents of the bari had a fever in the past 7 days? | |
|Yes (1) No (2) | |
|(ÓnvÓ n‡j 1c Ges 1d ‡Z hvb, bv n‡j 2 G hvb) (If ‘yes,’ go to 1c and 1d. If ‘no,’ go to 2.) | |
|1c. hw` 1b nu¨v nq, wRÁvmv Ki“b: Zvi KZ w`b R¡i wQj ? রেকর্ড করুন: bvg I KZ w`b R¡i wQj (99 = Rvwb bv ) | |
|1c. If 1b is “yes,” ASK: How many days did s/he have fever? RECORD: Name and days of fever (99=don’t know) | |
|bvg/ Name___________________________ w`b / Days _____ | |
|bvg/ Name________________ ___________w`b / Days _____ | |
|bvg/ Name___________________________ w`b / Days _____ | |
|(1d চালিয়ে যান) (Continue to 1d.) | |
|1d. evoxi Kv‡iv wK MZ 7 w`‡b 2 w`b ev Zvi †ekx w`b a‡i R¡i wQj? |( |
|1d. Did anyone in the bari have fever for 2 or more days during the past 7 days? | |
|Yes (1) No (2) | |
| | |
|(ÓnvÓ n‡j evwo Dchy³ bq) (If ‘yes,’ this bari is ineligible) | |
|2. wRÁvmv Ki“b: Bb‡W· †Km wK GB evwo‡Z AvMvgx 20 w`b Nygv‡e? |( |
|2. ASK: Will the index case be sleeping in this bari for the next 20 days? | |
|Yes (1) No (2) | |
|(ÓbvÔ n‡j evwo Dchy³ bq) (If ‘no,’ this bari is ineligible) | |
|3. wRÁvmv Ki“b: Bb‡W· †Km QvovI Av‡iv 2 ev Zvi †ewk †jvKRb wK GB evwo‡Z AvMvgx 20 w`b _vK‡e? |( |
|3. ASK: Will 2 or more other persons, other than the index case, be living in your bari during next 20 days? | |
| | |
|Yes (1) No (2) | |
|ÓbvÔ n‡j evwo Dchy³ bq| (If ‘no,’ this bari is ineligible) | |
|4. wRÁvmv Ki“b: Avcbvi evwowU wK Avgv‡`i M‡elYvq BwZc~‡e© ‡bqv n‡qwQ‡jv? |( |
|4. ASK: Was your Bari enrolled before in our Study? | |
|Yes (1) No (2) | |
|ÓnvÓ n‡j evwo Dchy³ bq| (If ‘yes’, this bari is ineligible) | |
|5. রেকর্ড করুন: evwo wK Dc‡ii AšÍ©f~w³ KiY wbq‡gi g‡a¨ c‡i‡Q? |( |
|5. RECORD: Does the bari meet the above inclusion criteria? | |
|Yes (1) No (2) | |
|(ÓnvÓ n‡j বাড়ি সম্মতি চালিয়ে যান।‘না’ হলে বাড়ি উপযুক্ত নয়, ধন্যবাদ দিন। | |
|(If ‘yes’, continue with Bari Consent. If ‘no’, bari is ineligible ( please thank them for their time) | |
| | |
|6. রেকর্ড করুন: evwoi cÖavb ev g‡bvbxZ cÖwZwbwa wK Lvbv AbygwZ c‡Î ¯^v¶i K‡i‡QY? |( |
|6. RECORD: Did the head of the bari, or appropriate designee, and any necessary household leaders accept and sign the household consent form? | |
|Yes (1) No (2) | |
|(ÓnvÓ n‡j বাড়ি সম্মতি চালিয়ে যান।‘না’ হলে বাড়ি উপযুক্ত নয়, ধন্যবাদ দিন। | |
|(If ‘yes’, continue with Bari Drawing. If ‘no’, this bari is ineligible( please thank them for their time) | |
| | |
|7. রেকর্ড করুন: ইনিউমেরেশন ফর্ম পূরণের কোনো পর্যায়ে আইসিপি Lvbvi †Kvb m`m¨i (AvBwmwc e¨vwZZ) MZ 7 w`‡bi g‡a¨ R¡i wQj e‡j Rvbv †M‡Q wK A_ev †Kvb evox m`m¨i|( |
|(AvBwmwc _vbvi evB‡i) MZ 7w`‡bi g‡a¨ 2 ev Zvi †ekx w`b R¡i wQj e‡j Rvbv †M‡Q wK ? | |
|7. RECORD: At any point while completing the Enumeration Form, was a resident of the ICP household (other than the ICP) found to have fever during | |
|the last 7 days, or was a bari resident (outside the ICP household) found to have had a fever for two or more days during the last 7 days? | |
|Yes (1) No (2) | |
|(‘না’ হলে গৃহস্থালী সংক্রান্ত প্রশ্নমালা চালিয়ে যান। ‘হা’ হলে বাড়ি উপযুক্ত নয়, ধন্যবাদ দিন) | |
|(If ‘no’, continue with Household Questionnaires .If ‘yes’, this bari is ineligible ( please thank them for their time) | |
cÖ_g wfwR‡U Rvb‡Z PvB‡Z n‡e: To be asked at the first visit to the household:
Amy¯’Zv UªvwKs†kl nIqvi ci DËi †`qvi R‡b¨ (A_ev Zvi c~‡e© Wªc AvDU Zvwi‡Li Dci wbf©ikxj)
To be answered after completion of illness tracking (or before depending on drop out date):
|8. Amy¯’Zv U¨vwKs Gi †Kv‡bv ch©v‡q wK evwo AskMÖn‡Y A¯^xK…wZ Rvwb‡q‡Q (যে কোনো কারণে)? |( |
|8. RECORD: Did bari discontinue study participation (for any reason) during illness tracking? Yes (1) No (2) | |
| | |
|ÓnvÓ n‡j wb‡P KviY e¨vL¨v Kiæb| (If ‘yes’, explain why below) | |
| 9. Wªc AvD‡Ui KviY 9. Explanation of household drop out: |
| |
| |
| |
|10. Wªc AvD‡Ui ZvwiL _____/______/_______Date of drop out (dd/mm/yyyy):_____/______/_______ |
Appendix 7: Bari Drawing Form VERSION 18.5.10
Use the symbols below to draw a picture to represent the bari.
Symbol Definitions:
= Housing Structure = Cooking Area (Stove) = Toilet Facilities = Entrance to Bari
(draw the most used entrance)
= Handwashing station -- -- -- -- = Draw a dashed line between the front entrance of housing structure “01”
and the nearest front entrance of each other numbered structure.. Label each line
with the length in steps.
= Entrance(s) to Housing Structure = Water source = Intervention handwashing station (draw next day)
| | | |
ICP ID: FRA Code:
Appendix 8: Household Contact Enumeration Form (VERSION 07.07.2010) ICP Household (1) Secondary Household (2)
Date (dd/mm/yy) :___ ___/ ___ ___/ ___ ___ Code of FRA: ((( Household Unique ID# : (((((((( Call to FRO: Yes=1, No=2 (
Name of Respondent: _________________________ Did household participate in bari consent (1) or consent as an individual household (2)? (
ASK Primary Respondent: “Who are the members of your khana?” List whoever the respondent lists. Include guests if the respondent lists them; otherwise DO NOT.
| Individual Number |
Appendix 8: Household Contact Enumeration Form (PAGE 2, if needed)
| Individual Number |
|Appendix 8b: Enrollment Day Sick List for all Bari members |
|If any member of the ICP household had fever during the last 7 days, the bari is ineligible for study participation. Do not continue with Sick List ( Return to Bari Eligibility Form |
| |
|List any bari member (including the ICP) that had fever, cough or sore throat during the last 7 days (including today), and record the number of days s/he had each symptom. |
| |Name |Unique ID |Number of days of fever during last 7|Date of Sample Collection|Number of days of cough |Number of days of sore |
| | | |days |(if fever is present on |during last 7 days |throat during last 7 days |
| | | | |day of enrollment) | | |
| | | |Last day of symptoms (dd/mm/yy) or | |Last day of symptoms |Last day of symptoms |
| | | |today’s date |(dd/mm/yy) |(dd/mm/yy) |(dd/mm/yy) or today’s date |
| | | |99= don’t know | |or today’s date | |
| | | | | | |99= don’t know |
| | | |If any bari member (outside the ICP | |99= don’t know | |
| | | |household) had fever for 2 or more | | | |
| | | |days during the last 7 days, the bari| | | |
| | | |is ineligible for study participation| | | |
| | | |( Return to Bari Eligibility Form | | | |
|1 |
End of Section One
‡mKkb 2: Ávb Section Two: Knowledge
| |(‡mvqvBb d¬z) Swine Flu |(Bbd¬z‡qÄv) Influenza Illness |
|2.1 DËi`vZv‡K wRÁvmv Ki“b |(( |(( |
|ÒAvcwb wK KL‡bv _______________ kãwU ï‡b‡Qb?Ó |( DËi 02 ev 99 n‡j ciewZ© Kjv‡g P‡j hvb |( DËi 02 ev 99 n‡j cªkœ 2.28-G P‡j hvb |
|(ev‡´ †KvW wjLyb ) |If the answer is 02 or 99, SKIP to next column |If the answer is 02 or 99, SKIP to question |
|ASK: Have you ever heard of the word_______? | |2.28 |
|(Record code in box) |( DËi 01 n‡j GB Kjvg Pvwj‡q hvq| | |
|- j¶¨ Ki“b: †Kv‡bvfv‡eB †mvBb d¬z ev Bbd¬z‡qÄvwel‡q e¨vL¨v Ki‡eb bv |If the answer is 01, continue down This column |( DËi 01 n‡j GB Kjvg Pvwj‡q hvq| |
|| ïay cÖkœKi“b, Zviv GB kãwUï‡b‡Q wK bv? | |If the answer is 01, continue down This column |
|--NOTE: Do not explain the terms& “swine flu” or “influenza illness”| | |
|in any way. Simply ask if they know the word/term. | | |
|Yes (n¨uv) 01 | | |
|No (bv) 02 | | |
|Don’t Know/Not Sure (Rvwb bv) 99 | | |
|2.2 Avcwb wK Rv‡bb,-------------G †Kvb j¶Y †`Lv †`q? |(( |(( |
|ASK, Do you know what symptoms can occur with______? |( DËi 02 ev 99 n‡j cªkœ 2.4-G P‡j hvb |( DËi 02 ev 99 n‡j cªkœ 2.4-G P‡j hvb |
|Yes (n¨uv) 01 |If the answer is 02 or 99, SKIP to question 2.4|If the answer is 02 or 99, |
|No (bv) 02 | |SKIP to question 2.4 |
|Don’t Know/Not Sure (Rvwb bv) 99 | | |
|2.3 DËi`vZv‡K wRÁvmv Ki“Y ------- G †Kvb †Kvb j¶Y †`Lv ‡`q ? | Kvwk (Cough) ___ | Kvwk (Cough) ___ |
|ASK: What symptoms are associated with _____? |Mjve¨_v (Sore throat) ___ |Mjve¨_v (Sore throat) ___ |
| |bvK Siv (Runny nose) ___ |bvK Siv (Runny nose) ___ |
|(Ackb¸‡jv D”P¯^‡i c‡o †kvbv‡eb bv) |R¡i (Fever) ___ |R¡i (Fever) ___ |
|(G cÖkœwU †Lvjv cÖ‡kœi gZ K‡i wR‡Ám Ki“b, DËi`vZv cv‡ki ZvwjKvi |gv_v e¨_v (Headache) ___ |gv_v e¨_v (Headache) ___ |
|DcmM©¸‡jv D‡jøL Ki‡j n¨uv =1 , bv =2, †KvW Kiyb)| |kixi e¨_v (Body Aches) ___ |kixi e¨_v (Body Aches) ___ |
|Avcwb cÖ‡qvRb‡ev‡a ÒAvi wKQyÓ K_vwU `yBevi wR‡Ám Ki‡Z cv‡ib| |Wvqwiqv(Diarrhea) ___ |Wvqwiqv(Diarrhea) ___ |
| |nuvwP (Sneezing) ___ |nuvwP (Sneezing) ___ |
|(DO NOT READ RESPONSE OPTIONS ALOUD Ask this as an open-ended |ewg (Vomiting) ___ |ewg (Vomiting) ___ |
|question. If the respondent mentions the listed symptom, write “1” |‡Pv‡Li mgm¨v |‡Pv‡Li mgm¨v |
|for “yes” in the space, write “2” for “no”. May ask “anything else?”|(Eye Problems) ___ |(Eye Problems) ___ |
|twice if appropriate.) |Ab¨vb¨, wb‡P wbw`©ó Ki“b |Ab¨vb¨, wb‡P wbw`©ó Ki“b |
| |(Other, specify below) ___ |(Other, specify below) ___ |
|Yes(n¨uv) 1 | | |
|No(bv) 2 |_______________________ |_______________________ |
| |Swine Flu |Influenza Illness |
|2.4 ______ gvby‡li wKfv‡e nq? | | |
|ASK, How a person can get sick with __________? | | |
|((cQ›`¸‡jv D”P¯^‡i c‡o †kvbv‡eb bv) G cÖkœwU †Lvjv cÖ‡kœi gZ K‡i wR‡Ám Ki“b, DËi`vZv cv‡ki ZvwjKvi | | |
|DcmM©¸‡jv D‡jøL Ki‡j n¨uv =1 , bv =2, †KvW Kiyb)| Avcwb cÖ‡qvRb‡ev‡a ÒAvi wKQyÓ K_vwU `yBevi wR‡Ám Ki‡Z | | |
|cv‡ib|) | | |
|(DO NOT READ RESPONSE OPTIONS ALOUD Ask this as an open-ended question. If the respondent mentions the | | |
|listed symptom, write “1” for “yes” in the space, write “2” for “no” in the space. May ask “anything else?”| | |
|twice if appropriate.) | | |
|Yes(n¨uv) 1 | | |
|No(bv) 2 | | |
|a. _____†ivMxi ms¯ú‡k© _vK‡j Close contact with ________ patient |a. ( |a. ( |
|b. cÖvbxi ms¯ú‡k© Contact with animals |b. ( |b. ( |
|c. RxevbyMÖ¯Í e¯‘ †_‡K (wUDeI‡q‡ji nvZj, †dvb) Contact with contaminated surfaces (tube well handles, |c. ( |c. ( |
|phones) | | |
|d.†bvsiv nv‡Z †L‡j ev LvIqv ˆZix Ki‡j Eating or preparing food with dirty hands |d. ( |d. ( |
|e. GKB _vjv-evmb, PvgP (ˆZRmcÎ) fvMvfvwM Ki‡j Sharing utensils |e. ( |e. ( |
|f. Rxevbyhy³ cvwb ev Lvevi †L‡j Contaminated drinking water or food |f. ( |f. ( |
|g. †hŠb m¤úK© Sexual relations |g. ( |g. ( |
|h. †bvsiv _vK‡j/A¯^v¯’¨Ki _vK‡j (¯^vfvweK fv‡e, nvZ cwi®‹vi Kivi K_v ejv nq bvB) Being dirty/poor hygiene |h. ( |h. ( |
|(general, no mention of hand cleanliness | | |
|i. †bvsiv _vK‡j/A¯^v¯’¨Ki _vK‡j, (we‡klZ nvZ Acwi®‹vi _vK‡j ev evievi nvZ bv ay‡j) Being dirty/poor |i. ( |i. ( |
|hygiene (hands specifically – having dirty hands or not washing hands enough) | | |
|j. মশা বা অন্য ‡cvKv-gvK‡oi Kvgo †_‡K Insect bite (mosquito or other insect) |j. ( |j. ( |
|k. fvBivm/e¨vK‡Uwiqv/Rxevby Virus/Bacteria/Germs |k. ( |k. ( |
|l. Ab¨vb¨/wbw`©ó Ki“b Other (specify) |l. ( |l. ( |
| |If “other”, specify: |If “other”, specify: |
| |___________________________|___________________________|
| |_____ |_____ |
|m. Rvwb bv/ wbwðZ bB| Don’t know/not sure |m. ( |m. ( |
| |(‡mvqvBb d¬z) Swine Flu |(Bbd¬z‡qÄv) Influenza Illness |
|2.5 DËi`vZv‡K wRÁvmv Ki“b Ò______ wK cÖwZ‡iva/†VKv‡bv hvq?Ó |(( |(( |
|(ev‡´ †KvW wjLyb) |If the answer is 02 or 99, skip to top of next |If the answer is 02 or 99, skip to 2.9 |
|ASK: “Can _____________ be prevented?” |column | |
|(Record code in box) | |DËi 02 ev 99 n‡j cÖkœ bs 2.9-G P‡j hvb |
| |DËi 02 ev 99 n‡j ciewZ© Kjv‡g P‡j hvb | |
|Yes (n¨uv) 01 | | |
|No (bv) 02 | | |
|Don’t Know/Not Sure (Rvwb bv) 99 | | |
|2.6 Avcbv Kv‡Q wK g‡b nq ________-- প্রতিরোধ/†VKv‡ bv কি সহজ অথবা |(( |(( |
|কঠিন? |If the answer is 99, skip to 2.8 |If the answer is 99, skip to 2.8 |
|ASK, Would you say that preventing the spread of __________ is | | |
|easy or difficult? |DËi 99 n‡j cÖkœ bs 2.8-G P‡j hvb |DËi 99 n‡j cÖkœ bs 2.8-G P‡j hvb |
| | | |
|সহজ Easy 01 | | |
|কঠিন Difficult 02 | | |
|জানি না/নিশ্চিত নই 99 | | |
|Don’t know/not sure | | |
|2.7 যদি উত্তরদাতা “সহজ” উত্তর দেয়, তবে জিজ্ঞেস করুন “আপনি কি বলবেন যে |(( |(( |
|এটি মোটামুটি সহজ না খুব সহজ?” | | |
| | | |
|(If respondent answered “easy”, ASK, Would you say that it is | | |
|somewhat easy or very easy? | | |
| | | |
|যদি উত্তরদাতা “কঠিন” উত্তর দেয়, তবে জিজ্ঞেস করুন “আপনি কি বলবেন এটি | | |
|মোটামুটি কঠিন না খুবই কঠিন?” | | |
| | | |
|(If respondent answered “difficult”, ASK, Would you say that it is | | |
|somewhat difficult or very difficult? | | |
| | | |
|মোটামুটি সহজ Somewhat Easy 01 | | |
|খুব সহজ Very Easy 02 | | |
|মোটামুটি কঠিন Somewhat Difficult 03 | | |
|খুবই কঠিন Very Difficult 04 | | |
|উত্তর দেবেন না Refused to answer 66 | | |
| |(‡mvqvBb d¬z) Swine Flu |(Bbd¬z‡qÄv) Influenza Illness |
|2.8 wRÁvmv Ki“b ______ wKfv‡e cÖwZ‡iva/†VKv‡bv hvq? |Amy¯’ e¨w³ †_‡K `~‡i _vKvi |Amy¯’ e¨w³ †_‡K `~‡i _vKvi |
|ASK: How can ___________ be prevented? |gva¨‡g |gva¨‡g |
| |(Keep away from ill persons) ____ |(Keep away from ill persons) ____ |
|(cQ›`¸‡jv D”P¯^‡i c‡o †kvbv‡eb bv) | | |
|G cÖkœwU †Lvjv cÖ‡kœi gZ K‡i wR‡Ám Ki“b, DËi`vZv cv‡ki |evievi nvZ †avqvi gva¨‡g |evievi nvZ †avqvi gva¨‡g |
|ZvwjKvi DcmM©¸‡jv D‡jøL Ki‡j n¨uv =1 , bv =2, †KvW Kiyb)| |(Wash hands frequently) ____ |(Wash hands frequently) ____ |
| | | |
| |evievi mvevb w`‡q nvZ †avqvi |evievi mvevb w`‡q nvZ †avqvi |
|(DO NOT READ RESPONSES ALOUD) |gva¨‡g (Wash hand with soap frequently) ____ |gva¨‡g (Wash hand with soap frequently) ____ |
|(Ask this as an open-ended question. If the respondent | | |
|mentions the listed prevention, write “1” for “yes”and “2” |wUKv †bIqvi gva¨‡g |wUKv †bIqvi gva¨‡g |
|for “no” in the space.) |(Vaccination) ____ |(Vaccination) ____ |
| | | |
| |VvÛv Lvevi bv †L‡j |VvÛv Lvevi bv †L‡j |
| |(Not taking cold foods) ____ |(Not taking cold foods) ____ |
|হ্যা Yes 1 | | |
|না No 2 |Ab¨vb¨, wbw`©ó K‡i wjLyb |Ab¨vb¨, wbw`©ó K‡i wjLyb |
| |(Other, specify below) ____ |(Other, specify below) ____ |
| | | |
| |___________________________ |___________________________ |
| | |Rvwb bv/ wbwðZ bB |
| |Rvwb bv/ wbwðZ bB |(Don’t know/not sure) ____ |
| |(Don’t know/not sure) ____ | |
| |ÕBbd¬z‡qÄvÕ Kjv‡g hvb | |
| |Go to ‘Influenza’ column | |
2.9. Avcwb gnvgvix kãwU ï‡b‡Qb? ((
ASK: Have you heard the word “epidemic”?
Yes (n¨uv) 01
No (bv) 02
Don’t Know/Not Sure (Rvwb bv) 99
2.10. Avcwb c¨vb‡WwgK ev wek¦-gnvgvix kãwU ï‡b‡Qb? ((
ASK: Have you heard the word “pandemic”?
Yes (n¨uv) 01
No (bv) 02
Don’t Know/Not Sure (Rvwb bv) 99
( DËi (2) ev (9) n‡j cÖkœ bs 2.12 G P‡j hvb (If (2) or (9), SKIP to question 2.12)
|2.11. †Kvb eQi †kl Bbd¬z‡qÄv wek¦-gnvgvix †`Lv w`‡qwQ‡jv? (((( |
|ASK: In which year did the last influenza pandemic occur? |
|--লক্ষ্য করুন: উত্তরদাতা যদি বাংলা সাল বলে, তবে তা ইংরেজীতে বদলে নিন।বর্তমান বাংলা সাল ১৪১৭ |
|NOTE: If answer is given in Bangla calendar years, convert to Roman calendar (Current Bangla year as of April 14th , 2010: 1417) |
|যদি উত্তর জানি না/নিশ্চিত নই হয়, তবে “9999” লিখুন। Write “9999” if “Don’t Know/Not Sure” |
2.12. †kl 12 gv‡m Avcbvi Lvbvi †KD wK ‡h †Kv‡bv Kvi‡Y nvmcvZv‡j fwZ© n‡qwQ‡jv? ((
ASK, Has anyone in your household been hospitalized for any reason in the last 12 months?
Yes (n¨uv) 01
No (bv) 02
Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99
( DËi (2) ev (99) n‡j cªkœ 2.15-G P‡j hvb (If (2) or (99), SKIP to question 2.15
|2.13 Avcbvi Lvbvi KqRb MZ ১২ মাস কোনো কারণে nvmcvZv‡j fwZ© n‡qwQ‡jv? (( |
|ASK, How many people in your household have been hospitalized for any reason in the last 12 months? |
| |
|2.14 গত ১২ মাসে hviv fwZ© n‡qwQ‡jv, Avcbvi g‡Z Zv‡`i KqRb শ্বাসকার্যের †Kv‡bv †iv‡Mi (( |
|যেমন জ্বর, কাশি, গলা ব্যাথা, নাক ঝরা, শ্বাস কষ্ট ইত্যাদি) Kvi‡Y fwZ© n‡qwQ‡jv? |
| |
|জানি না/উত্তর নেই এর জন্যে “99” কোড করুন। |
| |
|ASK, Of those people who were admitted to the hospital, in the last 12 months, how many people were hospitalized for a disease related to respiration (for example |
|- fever, cough, sore throat, runny nose, breathing difficulties)? |
|Write “99” for don't know/no answer |
| |
|2.15-2.21 Avwg আপনাকে এখন কিছু রোগের নাম বলবো এবং জানতে চাইবো কোন রোগটি আপনার বেশি ভয়ের কারণ?রোগগুলোর নাম আপনার জানা থাকতে পারে আবার নাও থাকতে পারে।আপনি প্রশ্নটি না |
|বুঝতে পারলে আমাকে বলবেন আর কোনো রোগের নাম চেনা না মনে হলেও বলবেন। |
|SAY, I shall tell you name of some diseases and ask you which one causes more worry to you. You may or may not know the names of those diseases. Please let me |
|know if you don’t understand my question and also let me know if any of the diseases are not known to you. |
|wR‡Ám Ki“b, Òwb‡Pi †Kvb †ivM Avcbvi me‡P‡q †ewk `ywðšÍvi/f‡qi KviY?Ó |
|ASK, Which illness is more concerning/causes more worry to you? |
|--লক্ষ্য করুন: যদি উত্তরদাতা বলে “দু্টার মধ্যে কোন রোগ বেশি দুশ্চিন্তার কারণ, তা জানি না” তবে দয়া করে জোর দিয়ে বলুন এটি একটা মতামত এবং চিন্তা করে বলতে কোন্ রোগ বেশি দুশিন্তার |
|কারণ? |
|--লক্ষ্য করুন: যদি কেউ একটি রোগ সম্পর্কে জানে, অন্যটি জানে না, তবে লিখুন “99”. |
|--লক্ষ্য করুন: যদি কেউ একটি রোগ সম্পর্কে না জানে, তবে সেই রোগটি যতোটি অপশনে আছে, তার প্রতিটিতে লিখুন“99” |
|--NOTE: If respondent says they “do not know which one is more concerning,” please stress that this is an opinion and ask them to think about which one is more |
|concerning for them. |
|--NOTE: If someone is concerned about one, but does not know of the other, write “99”. |
|--NOTE: If someone does not know one of the diseases, you can automatically write “99” anytime that disease is listed. |
| | |
|2.23 Avcwb wK g‡b K‡ib 5 †_‡K 1৭ eQর eqmx ¯‹z‡j hvIqv wkïi †¶‡Î Bbd¬z‡qÄv †iv‡M f~‡M g„Zz¨ NUvi m¤¢vebv আছে? |(( |
|Do you think it is likely that a child 5-17 years old with influenza would die ,? | |
|2.24 Avcwb wK g‡b K‡ib cÖvßeq¯‹ gvby‡li †¶‡Î Bbd¬z‡qÄv †iv‡M f~‡M g„Zz¨ NUvi m¤¢vebv আছে? |(( |
|Do you think it is likely that a person with influenza would die if they are an adult? | |
|2.25 Avcwb wK g‡b K‡ib e„× e¨w³i †¶‡Î Bbd¬z‡qÄv †iv‡M f~‡M g„Zz¨ NUvi m¤¢vebv আছে? |(( |
|Do you think it is likely that a person with influenza would die if they are an elderly person? | |
|2.26 Avcwb ev Avcbvi Lvbvi †jvKRb Bbd¬z‡qÄv wel‡q LeivLei †Kgb K‡i ‡c‡q _v‡Kb? | |
|ASK, How you or the people living in your household obtained information about influenza? | |
|(cQ›`¸‡jv D”P¯^‡i c‡o †kvbv‡eb bv) | |
|G cÖkœwU †Lvjv cÖ‡kœi gZ K‡i wR‡Ám Ki“b, DËi`vZv নিচের ZvwjKvi লক্ষণ¸‡jv D‡jøL Ki‡j n¨uv =1 , bv =2, †KvW Kiyb)| | |
|(DO NOT READ RESPONSE OPTIONS ALOUD) | |
|(Ask this as an open-ended question. If the respondent mentions the listed symptom, write “1” for “yes” “2” for “no” .) | |
| | |
|--লক্ষ্য করুন: প্রাইমারী রেসপন্ডেন্ট যে উত্তর দেয়, শুধু তাই রেকর্ড করুন। |Yes 01 |
|--NOTE: Please only record responses that the primary respondent says. |No 02 |
|a. (†iwWI) Radio |(( |
|b.. (†Uwjwfkb Television |(( |
|c.. (Le‡ii KvMR) Newspaper |(( |
|d.. (হাসপাতাল/Dc‡Rjv ¯^v¯’¨ †K›`ª ev ¯^v¯’¨ Kgx© Wv³vi /bvm©) Health professional - Hospital, Upazilla Health Center/Healthcare provider (doctor, |(( |
|nurse), Community health worker or pharmacist | |
|e. (eÜz-evÜe, mnKg©x, evwoi m`m¨, প্রতিবেশী) Social Circle - Family and friends, Co(w)-workers, Bari members or neighbors |(( |
|f. (agxq †bZv ev gmwR`/gw›`i) Religious leader or church/temple |(( |
|g. ক্লিনিক্যাল সেটিং বা ফিল্ডে বিসটিস দলের সঙ্গে যোগাযোগের মাধ্যমে |(( |
|Contact with BISTIS team in field or in clinical setting (current or previous contact) | |
|h. ক্লিনিক্যাল সেটিং বা ফিল্ডে আইসিডিডিআর, বি (বিসটিস নয়) দলের সঙ্গে যোগাযোগের মাধ্যমে |(( |
|Contact with ICDDR,B in field or clinical setting (other than BISTIS project) | |
|i.স্কুল/ School |(( |
|j. (Avwg Bbd¬z‡qÄv wel‡q †Kv‡bv Z_¨ cvB bvB) I have not received any information about influenza |(( |
|k. (Rvwb bv/wbwðZ bB) Don’t know/not sure |(( |
|l. (উত্তরদাতা প্রশ্ন বোঝেন নাই এবং কোনো উত্তর নাই) |(( |
|Respondent does not understand question and has no response | |
|m. (Ab¨vb¨/wbw`©ó Ki“b) Other (specify) |(( |
|__________________________________________________________________________ | |
2.27 weMZ 6 gv†m Lvbvi †Kv‡bv m`m¨ Bbd¬‡qÄv ev সোয়াইন ফ্লূ wUKv wb‡qwQ‡jv wK? ((
ASK: Has anyone in your household received a vaccination for influenza or swine flu in the past six months?
Yes (n¨uv) 01
No (bv) 02
Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99
← DËi hw` nu¨v nq, Z‡e †h ev hviv wUKv wb‡qwQ‡jv, Zviv †Kv_vq wb‡qwQ‡jv D‡jL Ki“b| j¶¨ ---Ki“b: GwU n‡jv wUKv cÖ`v‡bi ¯’vb, †hgb ¯‹z‡j, Kv‡Ri ¯’v‡b BZ¨vw` kix‡ii †Kv‡bv ¯’vb bq|
← If yes, please indicate where that person (those people) received the vaccine:
--NOTE: This is the location, such as school, clinic, etc., where the vaccine was obtained (not the location on the body)
______________________________________________________________
( DËi (02) ev (99) n‡j cÖkœ bs 2.28 G P‡j hvb (If 02 or 99, SKIP to question 2.28)
|2.27b wR‡Ám Ki“b: Avcwb wK Avgv‡K wUKv KvW© †`Lv‡Z cv‡ib? (( |
|†imc‡Û›U wK Avcbv‡K KvW© †`wL‡q‡Q? |
|ASK: Can you show me the vaccination card? |
|Does respondent show you? |
|Yes (n¨uv) 01 |
|No (bv) 02 |
|Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99 |
2.28 hw` DËi`vZv AvBwmwc না nq, তবে wR‡Ám Ki“b MZ GK gv‡mi g‡a¨ Avcbvi R¡i n‡qwQ‡jv wK? ((
hw` DËi`vZv AvBwmwc nq তবে wR‡Ám Ki“b eZ©gvb জ্বর Qvov MZ GK gv‡mi g‡a¨ Avcbvi
R¡i n‡qwQ‡jv wK?
If respondent is NOT the ICP (ASK: Have you had a fever within the last month?
If respondent is the ICP (ASK: Apart from this current fever, have you had a fever within the last month?
--লক্ষ্য করুন: এক মাস পূর্বে তারিখ কতো ছিলো, তা আপনি জানাতে পারেন।
--NOTE: You may indicate what the date was one month prior.
Yes (n¨uv) 01
No (bv) 02
Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99
( hw` DËi 02 ev 99 nq, cÖkœ 2.43-G hvb| (If 02 or 99, SKIP to question 2.43)
|2.29-2.42 wR‡Ám Ki“b MZ GK gv‡mi g‡a¨ hLb Avcbvi R¡i n‡qwQ‡jv, wb‡Pi KvR¸‡jvi GKwUI K‡iwQ‡jb wK? |
|এরপর একটি একটি করে অপশন পড়ে শোনান এবং উত্তর রেকর্ড করুন। |
|ASK, “When you had a fever within the last month, did you do any of the following?” |
|Then read choices one at a time and record the respondent’s responses. |
|( cÖ‡qvRb n‡j †evSvi myveav‡_© wR‡Ám Ki“bÓ MZ GKgv‡mi g‡a¨ hLb Avcbvi R¡i n‡qwQj Avcwb wK---------------? |
|( If necessary, for clarification at any time, ASK, “When you had a fever within the last month___________?” |
|Yes (n¨uv) 01 |
|No (bv) 02 |
|উত্তরদাতা প্রশ্ন বোঝেন নাই এবং কোনো উত্তর নাই |
|Respondent does not understand question and has no response 33 |
|Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99 |
| |
|2.29 স্বাভা্বিক সময়ের চেয়ে বেশি বেশি nvZ ধুয়েছিলেন? |
|Did you wash your hands more frequently than usual? |
|(( |
| |
|2.30 nuvwP ev Kvwki mg‡q Kvco ev KbyB w`‡q gyL ঢেকেছিলেন? |
|Did you cover your cough or sneeze with tissue or your elbow? |
[2.43-2.58] BwbDwg‡ikb dg© †`‡L †ei Ki“b Lvbvq (nvDR‡nv‡ì) 5 eQ‡ii Kg eqmx †Kv‡bv wkï i‡q‡Q wK bv| hw`
_v‡K, Z‡e wb‡Pi cÖkœwU Ki“b| hw` bv _v‡K, Z‡e cÖkœ bs 2.59 G P‡j hvb|
Check Enumeration Form to see if there is a child who is less than 5 years of age in the household.
(If there is a child under 5, ask this question:
(If there is no child less than 5 years old, SKIP to question 2.59
2.43 Avcwb wK cÖavbZ একজন 5 eQ‡ii Kg eqmx wkïi †`Lv‡kvbvকারী ev প্রাথমিক cwiPh©vকারী? ((
Are you a primary caretaker for a child that is less than 5 years of age?
Yes (n¨uv) 01
No (bv) 02
( hw` 02 DËi nq Z‡e 2.59G P‡j hvb| If 02, SKIP to question 2.59
2.44 hw` 5 eQ‡ii Kg eqmx wkï AvBwmwc না nq, Z‡e wR‡Ám Ki“Y Avcbvi cwiPh©vq _vKv 5 eQ‡ii Kg eqmx †Kv‡bv wkïi MZ GK gv‡m R¡i n‡qwQ‡jv wK?
hw` 5 eQ‡ii Kg eqmx wkï AvBwmwc nq , তবে wR‡Ám Ki“Y (আইসিপির নাম)এর) eZ©gvb জ্বর Qvov Avcbvi cwiPh©vq _vKv 5 eQ‡ii Kg eqmx অন্য†Kv‡bv wkïi MZ GK gv‡m R¡i n‡qwQ‡jv wK?
((
If child less than 5 years old is NOT the ICP, (ASK: Has a child under your care, who is less than 5 years old, had a fever in the past month?
If child less than 5 years old is the ICP, (ASK: Apart from (name of ICP)’s current fever, has (name of ICP) or another child under your care, who is less than 5 years old, had a fever in the past month?
-লক্ষ্য করুন: এক মাস পূর্বে তারিখ কতো ছিলো, তা আপনি জানাতে পারেন।
--NOTE: You may indicate what the date was one month prior.
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
( hw` DËi 02 ev 99 nq, cÖkœ 2.59-G hvb| If 02 or 99, SKIP to question 2.59
|[2.45-2.58] wR‡Ám Ki“Y Avcbvi 5 eQ‡ii Kg eqmx mšÍv‡bi MZ GK gv‡mi g‡a¨ hLb R¡i n‡qwQ‡jv, ZLb wb‡Pi KvR¸‡jvi একটিও K‡iwQ‡jb wK? |
|(এরপর এক এক করে অপশন পড়ে শোনান এবং উত্তর রেকর্ড করুন। |
|ASK, “When a child under your care, who is less than 5 years old, had a fever within the last month, did you do any of the following?” Then read choices one |
|at a time and record the respondent’s responses. |
|( cÖ‡qvRb n‡j †evSvi myveav‡_© wR‡Ám Ki“bÓ MZ GKgv‡mi g‡a¨ hLb GB wkïwUi R¡i n‡qwQj Avcwb wK---------------? |
|(If necessary, for clarification at any time, ASK, “When this child had a fever within the last month,_______________?” |
| |
|-j¶¨ Ki“b: hw` DËi`vZvi cwiPh©vq G‡Ki AwaK wkï _v‡K hv‡`i MZ GK gv‡m R¡i n‡qwQ‡jv, †m‡¶‡Î me‡P‡q Kg eqmx wkïi †¶‡Î DËi cÖ‡hvR¨ n‡e| |
|-NOTE: If respondent has more than one child under their care who had a fever within the last month, the answers will be applicable for the youngest child. |
|Yes (n¨uv) 01 |
|No (bv) 02 |
|উত্তরদাতা প্রশ্ন বোঝেন নাই এবং কোনো উত্তর নাই |
|Respondent does not understand question and has no response 33 |
|Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99 |
| |
|2.45 স্বাভাবিক সময়ের চেয়ে বেশি বেশি nvZ ধুয়েছিলেন? |
|Did you wash your hands more frequently? |
|(( |
| |
|2.46 Avcbvi wkïwU wK¬wbK ev nvmcvZv‡j wM‡qwQj? |
|Did your child visit a clinic or hospital? |
|(( |
| |
|2.47 Avcbvi wkï‡K Ab¨ †jv‡K‡`i Lye KvQvKvwQ রাখেন নি? |
|Did you have your child avoid close contact with other people? |
|(( |
| |
|2.48 Avcbvi wkï‡K ¯‹z‡j/Kv‡R/evRv‡i/KwgDwbwU †m›Uv‡i bv wb‡q evwo‡Z রেখেছিলেন? |
|Did you keep your child home from work/school/market/community centers? |
|(( |
| |
|2.49 Wv³v‡ii †cÖmwµckb QvovB dvgv©mx †_‡K Jla wK‡b wkï‡K Lvইয়েছেন ev N‡i ivLv Jla Lvইয়েছেন? |
|Did you give your child medicine from home or bought at a pharmacy without a doctor’s Prescription (self-medicate)? |
|(( |
| |
|2.50 Jlawe‡µZvi (mvwU©wd‡KU cvIqv dv‡g©mx÷ bb) m‡½ civgk© K‡i Jla খাইয়েছেন? |
|Did you seek help or medicine prescribed by a medicine seller (not a certified pharmacist)? |
|(( |
| |
|2.51এমবিবিএস বা অন্য সার্টিফিকেটধারী চিকিৎসকের (যেমন ফার্মেসীস্ট,প্যারামেডিক,নার্স, মেডিকেল এসিসটেন্ট, পরিবারপরিকল্পনা পরামর্শক ইত্যাদি) Dc‡`k Abyhvqx Jla খেয়েছিলেন? |
|Did you seek help or take medicine prescribed by a MBBS doctor or other certified medical professionals (certified pharmacist, paramedics, nurses, medical |
|assistants, family welfare visitors, etc.)? |
| |
|(( |
| |
|2.52 ‡nvwgIc¨vw_K Wv³v‡ii বা কবিরাজী/ঝাড়ফুক ইত্যাদির civgk© Abyhvqx Jla খেয়েছিলেন? |
|Did you seek help or medicine from a homeopathic doctor or a traditional healer? |
|(( |
| |
|2.53 †Rjv nvmcvZvj †_‡K webvg~‡j¨ A‡mëvwgwfi Jla পেয়েছিলেন? |
|Did you receive free Oseltamivir from a district hospital? |
|(( |
| |
|2.54 ঘরের evqy PjvPj বাড়ানোর ব্যবস্থা করেছিলেন? |
|Did you increase ventilation in your housing structure? |
|(( |
| |
|2.55 Ab¨‡`i সাথে একই _vjv-evm‡b wkï‡K Lvevi bv LvIqvন নি? |
|Did you avoid sharing drink or utensils with your child? |
|(( |
| |
|2.56 Avcbvi wkï‡K Ab¨‡`i ‡_‡K ‡_‡K Avjv`v Nygv‡Z দিয়েছিলেন? |
|Did you have your child sleep separately from others? |
|(( |
| |
|2.57 Ab¨vb¨ (wbw`©ó Ki“b) Other (specify): |
| |
|(( |
| |
[2.59- 2.74] BwbDwg‡ikb dg© †`‡L †ei Ki“b Lvbvq 5-17 eQi eqmx (5 Ges 17 eQimn) †Kv‡bv wkï i‡q‡Q wK bv| hw` _v‡K, Z‡e wb‡Pi cÖkœwU Ki“b| hw` bv _v‡K, Z‡e cÖkœ bs 2.84 G P‡j hvb|
Check Enumeration Form to see if there is a child who 5-17 years of age (including those that are 5 and 17) in the
household.
(If there is no child 5-17 years old, SKIP to question 2.84
(If there is a child 5-17 years old, ask this question:
2.59 Avcwb wK cÖavbZ একজন 5-17 eQi eqmx wkïi †`Lv‡kvbvকারী ev প্রাথমিক cwiPh©vকারী? ((
Are you a primary caretaker for a child that is 5-17 years of age?
Yes (n¨uv) 01
No (bv) 02
( hw` 02 DËi nq Z‡e 2.75G P‡j hvb| (If 02, SKIP to question 2.75)
2.60 hw` 5-17 eQi eqmx wkï AvBwmwc না nq তবে wR‡Ám Ki“b Avcbvi cwiPh©vq _vKv 5-17 eQi eqmx †Kv‡bv ((
wkïi MZ GK gv‡m R¡i n‡qwQ‡jv wK?
hw` 5-17 eQi eqmx wkï AvBwmwc হয়, তবে জিজ্ঞেস করুন, বর্তমান জ্বর ছাড়া (আইসিপির নাম)-এর বা অন্য কোনো
5-17 বছর বয়সী শিশু যাকে আপনি পরিচর্যা করেন, গত মাসে জ্বর হয়েছিলো কি?
If child between 5 and 17 years old is NOT the ICP, (ASK: Has a child under your care, who is between 5 and 17 years old, had a fever in the past month?
If child between 5 and 17 years old is the ICP, (ASK: Apart from (name of ICP)’s current fever, has (name of ICP) or another child under your care, who is between 5 and 17 years old, had a fever in the past month?
-লক্ষ্য করুন: এক মাস পূর্বে তারিখ কতো ছিলো, তা আপনি জানাতে পারেন।
--NOTE: You may indicate what the date was one month prior.
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
( hw` DËi 02 ev 99 nq, cÖkœ 2.75-G hvb| If 02 or 99, SKIP to question 2.75
|[2.61-2.74] wR‡Ám Ki“b Avcbvi পরিচর্যায় থাকা 5-17 eQ‡ii eqmx †Kv‡bv mšÍv‡bi hLb MZ মাসে R¡i n‡qwQ‡jv ZLb wb‡Pi KvR¸‡jvi †Kvb †KvbwU K‡iwQ‡jb? |
|(এরপর এক এক করে অপশন পড়ে শোনান এবং উত্তর রেকর্ড করুন। প্রয়োজনবোধে প্রশ্নটি প্রতিটি অপশনের সঙ্গে প্রশ্নটি পড়তে পারেন। |
|ASK, “When a child under your care, who is 5-17 years old, had a fever within the last month, did you do any of the following?” Then read choices one at a |
|time and record the respondent’s responses. |
| |
|(If necessary, for clarification at any time, ASK, “When this child had a fever within the last month,_______________?” |
| |
|-j¶¨ Ki“b: hw` DËi`vZvi cwiPh©vq 5-17 eQi eqmx G‡Ki AwaK wkï _v‡K hv‡`i MZ GK gv‡m R¡i n‡qwQ‡jv, †m‡¶‡Î me‡P‡q Kg eqmx wkïi †¶‡Î DËi cÖ‡hvR¨ n‡e| |
|-NOTE: If respondent has more than one child, between 5-17 years old, under their care who had a fever within the last two weeks, please report on their |
|actions regarding the YOUNGEST of those children. |
|Yes (n¨uv) 01 |
|No (bv) 02 |
|উত্তরদাতা প্রশ্ন বোঝেন নাই এবং কোনো উত্তর নাই |
|Respondent does not understand question and has no response 33 |
|Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99 |
| |
|2.61 স্বাভাবিকের চেয়ে বেশি বেশি nvZ ধুয়েছিলেন? |
|Did you wash your hands more frequently? |
|(( |
| |
|2.62 Avcbvi wkïwU wK¬wbK ev nvmcvZv‡j wM‡qwQj? |
|Did your child visit a clinic or hospital? |
|(( |
| |
|2.63 Avcbvi wkï‡K Ab¨ †jv‡K‡`i Lye KvQvKvwQ রাখেন নি? |
|Did you have your child avoid close contact with other people? |
|(( |
| |
|2.64 Avcbvi wkï‡K ¯‹z‡j/Kv‡R/evRv‡i/KwgDwbwU †m›Uv‡i bv wb‡q evwo‡Z রেখেছিলেন? |
|Did you keep your child home from work/school/market/community centers? |
|(( |
| |
|2.65 Wv³v‡ii †cÖmwµckb QvovB dvgv©mx †_‡K Jla wK‡b wkï‡K LvIqv‡bv ev N‡i ivLv Jla Lvইয়েছেন? |
|Did you give your child medicine from home or bought at a pharmacy without a doctor’s Prescription (self-medicate)? |
|(( |
| |
|2.66 Jlawe‡µZvi (mvwU©wd‡KU cvIqv dv‡g©mx÷ bb) m‡½ civgk© K‡i Jla খাইয়েছেন? |
|Did you seek help or medicine prescribed by a medicine seller (not a certified pharmacist)? |
|(( |
| |
|2.67 এমবিবিএস বা অন্য সার্টিফিকেটধারী চিকিৎসকের (যেমন ফার্মেসীস্ট,প্যারামেডিক,নার্স, মেডিকেল এসিসটেন্ট, পরিবারপরিকল্পনা পরামর্শক ইত্যাদি) Dc‡`k Abyhvqx Jla খাইয়েছিলেন? |
|Did you seek help or medicine prescribed by a MBBS doctor or from other certified medical professionals (certified pharmacist, paramedics, nurses, medical |
|assistants, family welfare visitors, etc.)? |
|(( |
| |
|2.68 ‡nvwgIc¨vw_K Wv³v‡ii বা কবিরাজী/ঝাড়ফুক ইত্যাদির civgk© Abyhvqx Jla খাইয়েছিলেন? |
|Did you seek help or medicine from a homeopathic doctor or a traditional healer? |
|(( |
| |
|2.70 †Rjv nvmcvZvj †_‡K webvg~‡j¨ A‡mëvwgwfi Jla পেয়েছিলেন? |
|Did you receive free Oseltamivir from a district hospital? |
[2.75-2.83]Avwg Avcbv‡K wKQy AvPiY m¤ú©‡K ej‡ev `qv K‡I, Avgv‡K ejyb wb‡Pi †Kvb †Kvb e¨envi Avcbv‡K শ্বাস-কাশির †ivM (যেমন জ্বর, কাশি, গলাব্যথা, নাক ঝরা, শ্বাসকষ্ট ইত্যাদি) Qov‡bvi nvZ †_‡K euvP‡Z সাহায্য করে?
SAY, I shall tell you about some behaviors. For the following, tell me if you think that the behavior would help you avoid the spread of repiratory diseases (including such as fever, cough, sore throat, runny nose, breathing difficulties).
cÖ‡hvR¨ †¶‡Î wR‡Ám Ki“b: ÒAvcwb wK g‡b K‡ib _______ Avcbv‡K †ivM Qov‡bvi †_‡K euvP‡Z সাহায্য করে?
( If necessary, for clarification at any time, ASK Do you think __________ help you avoid the transmission of disease ?
|Yes (n¨uv) 01 |
|No (bv) 02 |
|Don’t Know/Not Sure (Rvwb bv/ wbwðZ bB) 99 |
|2.75 Amy¯’ †jv‡Ki Lye KvQvKvwQ bv যাওয়া |(( |
|Avoiding close contact with persons that are sick? | |
|2.76 cvwb w`‡q nvZ †avqv |(( |
|Washing your hands with water? | |
|2.77 mvevb পানি w`‡q nvZ †avqv |(( |
|Washing your hands with soap and water? | |
|2.78 evRvi Ges Ab¨ Rbeûj ¯’vb Gwo‡q Pjv |(( |
|Avoiding going to the market and other public meeting places? | |
|2.79 †KD Amy¯’ n‡j N‡ii evqy PjvPj evov‡bvi e¨e¯’v Kiv |(( |
|Increasing ventilation in the household when a member is sick? | |
|2.80 nvZ bv †gjv‡bv/হ্যান্ডশেক না করা |(( |
|Avoid shaking hands? | |
|2.81 Amy¯’ e¨w³‡K Avjv`v ivLv |(( |
|Isolating a sick person from other individuals? | |
|2.82 wUKv †bqv |(( |
|Getting a vaccine? | |
|2.83 gvm&K বা অন্য কিছু দিয়ে মুখ-নাক ঢেকে রাখা (হাত দিয়ে মুখ ঢেকে উত্তরদাতাকে দেখান) |(( |
|Covering your face or nose with a mask or other cloth? (PUT HAND OVER MOUTH TO DEMONSTRATE) | |
[2.84-2.93] আমি আপনাকে কিছু বাধা সম্পর্কে বলবো যেগুলো হয়তো রোগ থেকে নিজে বা পরিবারকে বাচাতে আপনার জন্যে সমস্যার কারণ হয়ে দেখা দিয়েছিলো।
বর্তমান অসুস্থতা ছাড়া ‡klevi hLb Avcwb ev Avcbvi Lvbvi †Kv‡bv wkï Amy¯’ n‡qwQ‡jv, ZLb †ivগের সংক্রমণ ‡VKv‡bvi R‡b¨ ev wPwKrmvi ‡¶‡Î wb‡Pi †Kvনোevavi m¤§yLxb n‡qwQ‡jb? (Ackb¸‡jv c‡o †kvbvb)
SAY, I shall tell you some barriers which might become a problem for protecting yourself and your family from diseases. Think about the last time (apart from this current illness) you or a child from your household was sick. Please tell me if you encountered any of the following barriers to preventing or treating the disease.
(READ RESPONSE OPTIONS )
cÖ‡qvRb n‡j †evSvi myveav‡_© wR‡Ám Ki“b †klevi hLb Avcwb ev Avcbvi Lvbi †Kvb wkï Amy¯’ n‡qwQj ZLb wK--------------?(If necessary, for clarification at any time, ASK, “The last time you or a child from your household was sick _________________________________?”
|Yes (n¨uv) 01 |
|No (bv) 02 |
|উত্তরদাতা প্রশ্ন বোঝেন নাই এবং কোনো উত্তর নাই |
|Respondent does not understand question and has no response 33 |
|(cÖ‡hvR¨ bq) এর প্রয়োজন ছিলো না Not applicable (illness did not require this) 55 |
|Don’t know/ Don’t remember (Rvwb bv/g‡b †bB) 99 |
|2.84 wPwKrmvi LiP †ewk ছিলো? |(( |
|Was healthcare too expensive? | |
|2.85 Jl‡ai `vg Lye †ewk ছিলো? |(( |
|Was medicine too expensive? | |
|2.86 wbR‡K ev cwievi‡K wKfv‡e †iv‡Mi nvZ †_‡K euvPv‡eb †m m¤ú‡K© LeivLe‡ii Afve ছিলো? |(( |
|Was there was a lack of information about what you could do to protect yourself or your family? | |
|2.87 ‡iv‡Mi nvZ †_‡K euvPvi Dcvq¸‡jv m¤ú‡K© cwi®‹vi Lei cvb bvB? |(( |
|Was information received about how to prevent or treat disease unclear? | |
|2.88 nvZ †avqvi cvwb wQ‡jv bv? |(( |
|Was water to wash hands was not available? | |
|2.89 nvZ †avqvi mvev‡bi `vg †ewk ছিলো A_ev cvIqv hvয় নি? |(( |
|Was soap to clean hands was too expensive or not available? | |
|2.90 Kv‡Ri R‡b¨ evwo‡Z _vKv m¤¢e nq wb? |(( |
|Were you unable to stay in the house because you had to go to work? | |
|2.91 evmvq wkï‡`i ‡`Lvi †KD wQ‡jv bv weavq Zv‡`i evwo‡Z ivLv m¤¢e nq wb? |(( |
|Were you unable keep the kids at home because there was nobody to watch them? | |
|2.92 Avjv`v K¶ bv _vKvq Amy¯’ e¨w³‡K Avjv`v ivLv m¤¢e nq wb ? |(( |
|Were you unable to isolate sick people because there is no separate room in your home? | |
|2.93 Ab¨vb¨, wbw`©ó Ki“b Other (Specify: _____________________) |(( |
‡mKkb 3t ivbœvNi I cÖavb Ny‡gi N‡ii evqy mÂvjb e¨e¯’vi g~j¨vqb
Section 3: Ventilation Assessment of Cooking area and Main Sleeping Place
DËi`vZv‡K cÖkœ Kiæb t Ò`qv K‡i Avcwb Avgv‡K Avcbvi Lvbvi ivbœv Kivi ¯’vbwU †`Lv‡eb wK?Ó
Ask to respondent: “Can you show me the cooking area that your household uses most often?”
j¶¨ Ki“b: ivbœvi ¯’vb ej‡Z ‡ewk e¨eüZ PzjvwU †h ¯’v‡b Aew¯’Z Zv‡K eySv‡bv n‡q‡Q|
--NOTE: Cooking area is defined by the location of the primary stove.
3.1 ch©‡e¶b: ivbœvN‡ii Ae¯’vb (ev‡´ †KvW wjLyb ) ((
Observation: Cooking area location (Record code in box):
evm¯’v‡bi Pvi †`Iqv‡ji wfZ‡i
(Within four walls of housing structure)……. 01
evm¯’v‡bi cv‡k Ges mivmwi evm¯’v‡bi mv‡_ mshy³
(Attached to and directly next to the housing structure) 02
evm¯’v‡bi cv‡k wKš‘ mivmwi evm¯’v‡bi mv‡_ mshy³ bq
(Attached to but NOT directly next to the housing structure) 03
j¶¨ Ki“b: GB †KvWwU e¨eüZ n‡e hLb ivbœvi ¯’vbwU N‡ii KvVv‡gvi mv‡_ mivmwi mshy³ wKšÍ ga¨eZ©x Ab¨ †Kvb K¶ i‡q‡Q (†hgb †÷vi i“g A_ev Mi“ QvM‡ji Ni) hv †kvevi Ni I ivbœvi ¯’vb‡K Avjv`v Ki‡Q
--NOTE: Use this code when the cooking area is attached to the housing structure, but there is some other room
(such as a storage area or animal room) separating the cooking area from where people sleep
evm¯’vb †_‡K Avjv`v
(Separate from living space) 04
j¶¨ Ki“b: ivbœvi ¯’vb I †kvevi N‡ii ga¨eZ©x ‡h‡Kvb cwigvb Lvwj RvqMv _vK‡j 04 †KvW© cÖ‡hvR¨ n‡e
--NOTE: Any separation between the cooking area and the housing structure should be coded as “04”
Ab¨vb¨, wb‡P wbw`©ó K‡i wjLyb
(Other, specify below) 99
_____________________________________________________________________________
3.2a ch©‡e¶b: ivbœvN‡ii QvDwb ev Pvjvi aib (ev‡´ †KvW wjLyb ) ((
Observe: Roof of cooking area (Record number in box):
--লক্ষ্য করুন: †h †Kv‡bv ai‡bi †`qvj GgbwK Kvc‡oi ˆZix n‡jI Zv Ò†`qvjÓ iæ‡c Mb¨ n‡e
--NOTE: Any material, even a tarp, should be considered a “roof”
Pvjv †bB No roof 01
AvswkK Pvjv Av‡Q Partial roof present 02
cwic~Y© Pvjv Av‡Q Complete roof present 03
( hw` DËi 3.2a Ò01Ó nq, Z‡e 3.6bs cÖ‡kœ P‡j hvb If answer to 3.2b is “01”, then SKIP to 3.6
3.2b ch©‡e¶b:ivbœvN‡ii ‡`qv‡ji aiY (ev‡· †KvW wjLyb) ((
Observe: Walls of cooking area (Record number in box):
-jÿ¨ Kiæb: †h †Kv‡bv ai‡bi †`qvj GgbwK Kvc‡oi ˆZix n‡jI Zv Ò†`qvjÓ iæ‡c Mb¨ n‡e
--NOTE: Any material, even a tarp, should be considered a “wall”
-jÿ¨ Kiæb: hw` Kgc‡ÿ¨ GKwU †`qvj AvswkK nq (A‡a©K D”PZvi), Ò2Ó wjLyb|
--NOTE: If at least one wall is a partial wall (1/2 height), select “02”
†Kv‡bv †`qvj †bB
(No walls) 01
AvswkK †`qvj (AvswkK eÜ)
[Partial walls (partially enclosed)] 02
c~Y© †`qvj (`‡ivRv Ges Rvbvjv ev‡` cy‡ivcywi eÜ)
[Full walls (completely enclosed (besides doors and windows)] 03
Ab¨vb¨ (wb‡P wbw`©ó Kiæb)
[Other (specify below)] 99
________________________________________________________________________
( hw` DËi 3.2b Ò1Ó nq, Z‡e 3.7bs cÖ‡kœ P‡j hvb If answer to 3.2b is 1, then SKIP to 3.7
( hw` DËi 3.2b Ò2Ó ev Ò9Ó nq, Z‡e 3.6bs cÖ‡kœ P‡j hvb If answer to 3.2b is 2 or 9, then SKIP to 3.6
3.3 ch©‡e¶b:ivbœvN‡ii evqy mÂvjb e¨e¯’v (ev‡´ †KvW wjLyb ) ((
Observe: Ventilation of the cooking area (Record code in box):
-- j¶¨ Ki“b:: †Kv‡bv Ò4Ó bs †KvW †bB|
--NOTE: There is no choice “4”
j¶¨ Ki“b:¯’vqxfv‡e eÜ Rvbvjv ev `iRv Mb¨ n‡e bv
--NOTE: Do not count windows or doors that appear to be permanently closed or blocked.
j¶¨ Ki“b:Ab¨ N‡ii mv‡_ ms‡hvMKvix Rvbvjv ev `iRv Mb¨ Ki‡Z n‡e
--NOTE: Doorways or windows leading to other rooms should be observed for this question.
ivbœvN‡ii Pvi w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q
At least one window or door in each of the 4 directions (in each of four walls) 01
ivbœvN‡ii wZb w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q
At least one window or door in each of 3 directions (in three walls) 02
ivbœvN‡ii wecixZ `yB w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q (DËi I `w¶Y)
At least one window or door in each of 2 opposing directions (in two opposing walls) 03
ivbœvN‡ii ‡h‡Kvb non-wecixZ w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q
At least one window or door in each of 2 non-opposing directions (in two non-opposing walls) 05
ivbœvN‡ii GKB w`‡K gyL K‡i `yBwU Rvbvjv ev `iRv Av‡Q (GKB †`qv‡j)
At least two windows/doors in only 1 direction (in one wall) 06
ivbœvN‡ii GKB w`‡K gyL K‡iGKwU Rvbvjv ev `iRv Av‡Q (GKB †`qv‡j)
Only one door or window in only 1 direction (in one wall) 07
Ab¨vb¨, wb‡P wbw`©ó K‡i wjLyb
Other (specify below) 99
__________________________________________________________________________
3.4 ch©‡e¶Y: ivbœvN‡ii evq~ mÂvjb e¨e¯’v, †`Iqvj I Qv‡`i ga¨eZ©x RvqMv (ev‡´ †KvW wjLyb) ((
Observe: Ventilation of cooking area, space between walls and roof (Record code in box):
--ga¨eZ©x RvqMv ej‡Z †`qvj I Qv‡`i g‡a¨ e¨eavb †evSv‡bv n‡q‡Q hv Avcbvi nv‡Zi cvÄvi me‡P‡q PIov ¯’v‡bi mgvb ev †ewk (সবচেয়ে চওড়া অংশটি মাপুন।)
--NOTE: A space is defined as any separation between the wall/partition and roof that is equal or greater to the widest part of your hand (measure the widest space)
PviwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between all 4 walls and roof………… 01
wZbwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between 3 walls and roof………………. 02
`yBwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between 2 walls and roof……………. 03
GKwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between 1 wall and roof ……………. 04
‡Kvb †`Iqvj I Qv‡`i ga¨eZ©x RvqMv bvB No space between any walls and roof……… 05
3.5 ch©‡e¶Y: ivbœvi ¯’v‡bi evqy PjvPj, †`qvj Ges †g‡Si ga¨eZ©x ¯’vb ((
Observe: Ventilation of cooking area, space between walls and floor (Record code in box)
-- j¶¨ Ki“b: ga¨eZ©x RvqMv ej‡Z †`qvj I †g‡Si g‡a¨ e¨eavb †evSv‡bv n‡q‡Q hv Avcbvi nv‡Zi cvÄvi me‡P‡q PIov ¯’v‡bi mgvb ev †ewk
--NOTE: A space is defined as any separation between the wall/partition and floor that is equal or greater to the widest part of your hand
PviwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between all 4 walls and floor…… 01
wZbwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between 3 walls and floor………… 02
`yBwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between 2 walls and floor………… 03
GKwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between 1 wall and floor………… 04
‡Kvb †`Iqvj I †g‡Si ga¨eZ©x RvqMv bvB No space between any walls and floor… 05
3.6 ch©‡e¶Y: ivbœvi ¯’vb cwigvc, ˆ`N©¨ Ges cÖ¯’ (K`g/cv w`‡q) msL¨vq wjLyb
Observe: Measurement of cooking space, length by width (in steps): Record Number Below
-- j¶¨ Ki“b: me‡P‡q j¤^v ˆ`N©¨ Ges me‡P‡q PIov cÖ¯’ Mb¨ Kiæb|
--NOTE: Measure longest length and widest width present
j¶¨ Ki“b:AvswkK K`‡gi Rb¨ wbKU¯’ c~Y© wjLyb ( †hgb 5.5 Gi Rb¨ 6 wjLyb)
--NOTE: Round up to the nearest step (for example, record 5.5 steps as 06)
(( (‰`N©¨ length) (( (cÖ¯’ width)
3.7 ch©‡e¶Y: ivbœvi ¯’vb †_‡K evm¯’v‡bi `–iZ¡ K`g/cv w`‡q(ivbœvi ¯’v‡bi me‡P‡q Kv‡Qi N‡ii `iRv †_‡K Pzjv ch©šZ cwigvc Kiæb)
Observation: Distance from cooking area to housing structure in steps (measure from the stove to the entrance of housing structure that most frequently entered when returning from the cooking area)Record number below: ((
j¶¨ Ki“b: ivbœv Kivi ¯’vb hw` Lvbvi wfZ‡i nq, Z‡e 00 †KvW Kiæb|
--NOTE: If the cooking area is inside the household, code 00.
j¶¨ Ki“b:AvswkK K`‡gi Rb¨ wbKU¯’ c~Y© wjLyb ( †hgb 5.5 Gi Rb¨ 6 wjLyb)
--NOTE: Round up to the nearest step (for example, record 5.5 steps as 06)
3.8 DËi`vZv wK AvBwmwc Lvbvi †jvK? ((
Is the respondent from the ICP household?
Yes (n¨uv) 01
No (bv) 02
( DËi ÒbvÓ n‡j †mKkb 4 G P‡j hvb If the answer to question 3.8 is “no”, SKIP to section 4
3.9 `qv K‡i (Index ‡ivMx) †h NiwU‡ †ewkifvM mgq Nygvq ‡mwU Avgv‡K †`Lv‡eb wK? ((
Ask the respondent: “Can you show me the room where the index case most often sleeps?”
Yes (n¨uv) 01
No (bv) 02
( DËi ÒbvÓ n‡j †mKkb 4 G P‡j hvb If the answer to question 3.9 is “no”, SKIP to section 4
3.10 ch©‡e¶Y: Nygv‡bvi ¯’v‡bi evqy mÂvjb e¨e¯’v (ev‡´ †KvW wjLyb ) ((
Observation: Ventilation of the sleeping space (Record code in box):
-- j¶¨ Ki“b: †Kv‡bv Ò4Ó bs AckY †bB|
--NOTE: There is no choice “4”
--Ny‡gi ¯’vb ej‡Z m¤¢ve¨ cÖv_wgK/Bb‡W· ‡ivMx †h ¯’v‡b Nygvq †mB ¯’vb‡K eySv‡bv n‡q‡Q
--NOTE: The “sleeping space” is the room in which the index case patient sleeps in. Count rooms as separate when you cannot see over the partition separating the two rooms while standing in front of partition
j¶¨ Ki“b:¯’vqxfv‡e eÜ Rvbvjv ev `iRv Mb¨ n‡e bv
--NOTE: Do not count windows or doors that appear to be permanently closed or blocked.
j¶¨ Ki“b:Ab¨ N‡ii mv‡_ ms‡hvMKvix Rvbvjv ev `iRv Mb¨ Ki‡Z n‡e
--NOTE: Doorways or windows leading to other rooms should be included in this question.
j¶¨ Ki“b: AvBwmwc †h N‡i Nygvq Zv ch©‡e¶Y Ki“b
--NOTE: Observe the room in which the ICP sleeps.
Nygv‡bvi N‡ii Pvi w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q
At least one window or door in each of the 4 directions (in each of four walls) 01
Nygv‡bvi N‡ii wZb w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q
At least one window or door in each of 3 directions (in three walls) 02
Nygv‡bvi N‡ii wecixZ `yB w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q (DËi I `w¶Y)
At least one window or door in each of 2 opposing directions (in two opposing walls) 03
Nygv‡bvi N‡ii ‡h‡Kvb non-wecixZ w`‡K Kgc‡¶ GKwU K‡i Rvbvjv A_ev `iRv Av‡Q
At least one window or door in each of 2 non-opposing directions (in two non-opposing walls) 05
Nygv‡bvi N‡ii GKB w`‡K gyL K‡i `yBwU Rvbvjv ev `iRv Av‡Q (GKB †`qv‡j)
At least two windows/doors in 1 direction (in one wall) 06
Nygv‡bvi N‡ii GKB w`‡K gyL K‡iGKwU Rvbvjv ev `iRv Av‡Q (GKB †`qv‡j)
Only one door or window in 1 direction (in one wall) 07
Ab¨vb¨, wb‡P wbw`©ó K‡i wjLyb
Other (specify below) 99
____________________________________________________________________
3.11 ch©‡e¶Y: Nygv‡bvi N‡ii evqy mÂvjb e¨e¯’v, †`qvj Ges Qv‡`i ga¨eZx© ¯’vb (ev‡´ †KvW wjLyb ) ((
Observation: Ventilation of sleeping space, space between walls and roof (Record code in box):
-- j¶¨ Ki“b: ga¨eZ©x RvqMv ej‡Z ‡eov/†`qvj I Qv‡`i g‡a¨ e¨eavb †evSv‡bv n‡q‡Q hv Avcbvi nv‡Zi me‡P‡q PIov ¯’v‡bi mgvb ev †ewk
--NOTE: A space is defined as any separation between the wall/partition and roof that is equal or greater to the widest part of your hand
--j¶¨ Ki“b: সবচেয়ে বড়ো স্থানটিকে পরিমাপ করুন।
--NOTE: Please observe the largest spaces and use these to determine whether a space is present or not.
PviwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between all 4 walls and roof………… 01
wZbwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between 3 walls and roof………………. 02
`yBwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between 2 walls and roof……………. 03
GKwU †`Iqvj I Qv‡`i ga¨eZ©x RvqMv Av‡Q Space between 1 wall and roof ……………. 04
‡Kvb †`Iqvj I Qv‡`i ga¨eZ©x RvqMv bvB No space between any walls and roof……… 05
3.12 ch©‡e¶Y: g~j evm¯’v‡bi evqy mÂvjb e¨e¯’v, †eov/†`qvj I ‡g‡Si ga¨Kvi RvqMv (ev‡´ †KvW wjLyb|)((
Observation: Ventilation of main living room, space between walls and floor (Record code in box):
--( j¶¨ Ki“b: ga¨eZ©x RvqMv ej‡Z ‡eov/†`qvj I ‡g‡Si g‡a¨ e¨eavb †evSv‡bv n‡q‡Q hv Avcbvi nv‡Zi me‡P‡q PIov ¯’v‡bi mgvb ev †ewk)
--NOTE: A space is defined as any separation between the wall/partition and floor that is equal or greater to the widest part of your hand
PviwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between all 4 walls and floor…… 01
wZbwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between 3 walls and floor………… 02
`yBwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between 2 walls and floor………… 03
GKwU †`Iqvj I †g‡Si ga¨eZ©x RvqMv Av‡Q Space between 1 wall and floor………… 04
‡Kvb †`Iqvj I †g‡Si ga¨eZ©x RvqMv bvB No space between any walls and floor… 05
3.13 ch©‡e¶Y: Nygv‡bvi N‡ii cwigvc, ˆ`N¨©-cÖ¯’ cwigvc (K`g/ cv w`‡q ) msL¨vq wjLyb t
Observation: Measurement of sleeping space, length by width (in steps) Record numbers below:
-- j¶¨ Ki“b: me‡P‡q j¤^v ˆ`N©¨ Ges me‡P‡q PIov cÖ¯’ Mb¨ Kiæb|
--NOTE: Measure longest length and widest width present
j¶¨ Ki“b:AvswkK K`‡gi Rb¨ wbKU¯’ c~Y© wjLyb ( †hgb 5.5 Gi Rb¨ 6 wjLyb)
--NOTE: Round up to the nearest step (for example, record 5.5 steps as 06)
(( (‰`N©¨ length) (( (cÖ¯’ width)
3.14 Bb‡W· †Km †ivMx hLb GLv‡b Nygvb, ZLb Zvi mv‡_ mvavibZ Avi K‡ZvRb †jvK GLv‡b GKBmg‡q Nygvb?
ASK: “When the index case patient sleeps in this space, how many other people typically sleep in this space at the same time?” Record numbers below:
--j¶¨ Ki“b: ইনডেক্স কেস রোগী যে রুমে ঘুমায় সেটি গন্য করুন। পুরো স্ট্রাকচার গন্য করুবেন না।
--NOTE: Look at the room where the index case sleeps, not the entire housing structure.
((
End of Section Three
‡mKkb 4t nvZ‡avqvi ¯’v‡b mvev‡bi mnRcÖvc¨Zv (ch©‡e¶bK…Z)
Section 4: Availability of Soap at Handwashing Stations (observed)
DËi`vZv‡K wRÁvmv Ki“b -ÒAvcwb †ekxi fvM mgq ‡h ¯’v‡b Avcbvi nvZ †avb `qv K‡i Avgv‡K †mB ¯’vbwU ‡`Lv‡eb wK?
Ask the respondent: “Can you please show me where you most often wash your hands?”
4.1 ch©‡e¶Y: nvZ‡avqvi ¯’vbwU g~jZt †Kv_vq Aew¯’Z? (ev‡´ †KvW wjLyb ) ((
Observation: Record the location of the primary handwashing station: (Record code in box)
j¶¨ Ki“b-hw` Avcbv‡K nvZ †avqvi ¯’vbwU e¨env‡ii Rb¨ N‡ii KvVv‡gvi evB‡i †n‡U †h‡Z nq Zvn‡j nvZ †avqvi ¯’vbwU N‡ii evB‡i e‡j a‡i wbb|nvZ †avqvi ¯’vbwU GKwU Qv‡`i wb‡P n‡jI Zv Mb¨ bq| N‡ii evB‡i ej‡Z g~j KvVv‡gvi evB‡i †evSv‡bv n‡”Q|
--NOTE: If you have to walk outside the housing structure to use the handwashing station, consider the handwashing station to be outdoors.
--NOTE: It does not matter whether the handwashing station is under a roof or not, outdoors means outside the main housing structure.
N‡ii wfZ‡i (cÖavb Kv‡Vv‡gvi wfZ‡i) /Indoors (within main housing structure) 01
N‡ii evB‡i-cÖavb Kv‡Vv‡gvi evB‡i Z‡e evoxi wfZ‡i/
Outdoors (outside main housing structure, within bari)
02
N‡ii evB‡i -evoxi evB‡i, cÖwZ‡ewki DVv‡b A_ev cyKz‡i/
Outdoors (outside bari, in neighbor’s yard or in pond)
03
†Kv‡bv wbw`©È ¯’v‡b bq/ No specific place 04
†`Lvi AbygwZ †bB/ No permission to see 05
Ab¨vb¨ (wbw`©ó Kiæb)/ Other (specify below) 88
_____________________________________________________________
(4.1 bs cÖ‡kœi DËi 3, 4 ev 5 n‡j 4.8 bs cÖ‡kœ P‡j hvb| (If the answer to question 4.1a is 3, 4 or 5, SKIP to question 4.8)
4.2 ch©‡e¶Y: nvZ †avqvi Rb¨ wbw`©ó ¯’v‡b cvwb Av‡Q wK?
Observation: Is water present at the specific place for handwashing?
ev‡´ †KvW wjLyb (Record code in box) ((
wb‡Ri †Pv‡L cvwb †`‡L ev‡´ n¨uv †KvW wjLyb
--NOTE: You must actually see water to record “yes”
j¶¨ Ki“b cwigvb A_ev gvb †Kvb mgm¨v bq| hw` †Kvb cvwb _v‡K Zvn‡j n¨v †KvW Ki“b|
--NOTE: The quantity and quality does NOT matter. If any water is present, code “yes”
Yes (n¨uv) 01
No (bv) 02
4.3a ch©‡e¶Y: nvZ †avqvi ¯’v‡b wb‡Pi †KvbwU Av‡Q? ( hw` Avcwb †KvbwU ch©‡e¶b K‡i _v‡Kb, Zvn‡j n¨uv =1, bv =2 ev‡· †KvW Ki“b)|
Observation: Which of the following are present at the handwashing station? (If you observe the listed item, write “1” for “yes” in the box below. If you do not observe the listed item, write “2” for “no” in the box below.)
j¶¨ Ki“b nvZ †avqvi ¯’v‡bi Pvi cv‡ki gvwU / evjyi Rb¨ gvwU / evjy †KvW Ki‡eb bv| hw` GKwU wbw`©ó cv‡Î ivLv _v‡K Ges nvZ †avqvi ¯’v‡b e¨eüZ nq Zvn‡j †KvW Ki“b
--NOTE: Do not record “mud/sand” if there is mud on the ground around the handwashing station. Record it if it is kept in a specific place or container and if there is evidence that it is kept intentionally to be used at the handwashing station for any purpose.
Yes (n¨uv) 01
No (bv) 02
mvevb (Bar soap) ((
cvDWvi/wWUvi‡R›U (Detergent powder) ((
Zij mvevb (Liquid soap) ((
QvB (Ash) ((
gvwU/evjy (Mud/Sand) ((
wKQzB †bB (None) ((
Ab¨vb¨, wbw`©ó Kiæb (Other, specify below) ((
____________________________________________
4.3b ch©‡e¶Y: g~j nvZ †avqvi ¯’vb †_‡K ivbœv Kivi ¯’v‡bi `yiæZ¡ (K`g w`‡q cwigvc Kiæb Ges wjLyb)
MEASURE: Distance from primary handwashing station to cooking area (in steps, measure to stove in cooking area)
ev‡´ †KvW wjLyb (Record code in box) ((
4.3c ch©‡e¶Y: g~j nvZ †avqvi ¯’vb †_‡K j¨vwUª‡bi ¯’v‡bi `yiæZ¡ (K`g w`‡q cwigvc Kiæb Ges wjLyb) †Kv‡bv j¨vwUªb bv _vK‡j wUK w`b|
MEASURE: Distance from primary handwashing station to latrine (in steps, measure to entrance of latrine) (Record number below)
If there is NO LATRINE, code “99”
ev‡´ †KvW wjLyb (Record code in box) ((
4.4 DËi`vZv‡K: wRÁvmv Ki“bt ÒGQvov Avi †Kv_vqI Avcwb nvZ †avb wK?
Ask the respondent: “Is there anywhere else you wash your hands?”
ev‡´ †KvW wjLyb (Record code in box) ((
Yes (n¨uv) 01
No (bv) 02
← hw` 4.4 Gi DËi 2 nqZ‡ e cÖkœ 4.8 G hvb (If answer to 4.4 is 2, skip to question 4.8)
4.5 ch©‡e¶Y: nvZ †avqvi wØZxq ¯’vbwU †Kv_vq Aew¯’Z? (ev‡´ †KvW wjLyb )
Observation: Record the location of the secondary handwashing station:
ev‡´ †KvW wjLyb (Record code in box) ((
N‡ii wfZ‡i /Indoors (within main housing structure) 01
N‡ii evB‡i-cÖavb Kv‡Vv‡gvi evB‡i Z‡e evoxi wfZ‡i/
Outdoors (outside main housing structure, within bari) 02
N‡ii evB‡i -evoxi evB‡i, cÖwZ‡ewki DVv‡b A_ev cyKz‡i/
Outdoors (outside bari, in neighbor’s yard or in pond) 03
†Kv‡bv wbw`©È ¯’v‡b bq/ No specific place 04
†`Lvi AbygwZ †bB/ No permission to see 05
Ab¨vb¨ (wbw`©ó Kiæb)/ Other (specify below) 88
_____________________________________________________________
( hw` 4.5 bs cÖ‡kœi DËi 3, 4 ev 9 nq, cÖkœ 4.8 G hvb (If the answer to question 4.5a is 3, 4 or 9, SKIP to question 4.8 )
4.6 ch©‡e¶Y: nvZ †avqvi Rb¨ wbw`©ó ¯’v‡b cvwb Av‡Q wK? (wb‡Ri †Pv‡L cvwb †`‡L ev‡´ n¨uv †KvW wjLyb )
Observation: Record if water is present at the specific place for handwashing? (You must actually see water to record “yes”):
ev‡´ †KvW wjLyb (Record code in box) ((
Yes (n¨uv) 01
No (bv) 02
4.7a ch©‡e¶Y: nvZ †avqvi ¯’v‡b wb‡Pi †KvbwU Av‡Q? (hw` Avcwb †KvbwU ch©‡e¶b K‡i _v‡Kb, Zvn‡j n¨uv =1 , bv =2 ev‡· †KvW Ki“b)| Observation: Which of the following are present at the handwashing station? (If you observe the listed item, write “1” for “yes” in the box below. If you do not observe the listed item, write “2” for “no” in the box below.)
j¶¨ Ki“b nvZ †avqvi ¯’v‡bi Pvi cv‡ki gvwU / evjyi Rb¨ gvwU / evjy †KvW Ki‡eb bv| hw` GKwU wbw`©ó cv‡Î ivLv _v‡K Ges nvZ †avqvi ¯’v‡b e¨eüZ nq Zvn‡j †KvW Ki“b
--NOTE: Do not record “mud/sand” if there is mud on the ground around the handwashing station. Record it if it is kept in a specific place or container and if there is evidence that it is kept intentionally to be used at the handwashing station for any purpose.
Yes (n¨uv) 01
No (bv) 02
mvevb (Bar soap) ((
cvDWvi/wWUvi‡R›U (Detergent powder) ((
Zij mvevb (Liquid soap) ((
QvB (Ash) ((
gvwU/evjy (Mud/Sand) ((
wKQzB †bB (None) ((
Ab¨vb¨, wbw`©ó Kiæb (Other, specify below) ((
___________________
4.7b ch©‡e¶Y: †m‡KÛvix nvZ †avqvi ¯’vb †_‡K ivbœv Kivi ¯’v‡bi `yiæZ¡ (K`g w`‡q cwigvc Kiæb Ges wjLyb)
Observation: Distance from secondary handwashing station to cooking area (in steps, measure to stove in cooking area) Record number below:
((
4.7c ch©‡e¶Y: †m‡KÛvix nvZ †avqvi ¯’vb †_‡K j¨vwUª‡bi ¯’v‡bi `yiæZ¡ (K`g w`‡q cwigvc Kiæb Ges wjLyb) †Kv‡bv j¨vwUªb bv _vK‡j wUK w`b|
Observation: Distance from secondary handwashing station to latrine (in steps, measure to entrance of latrine) Record number below:
j¨vwUªb bv _vK‡j 99 †KvW© Ki“b
If there is NO LATRINE, code “99”
((
4.8 DËi`vZv‡K wRÁvmv Ki“b - H¯’vb Qvov N‡ii wfZ‡i wb‡Pi †Kvb Dcv`vbwU i‡q‡Q? (DËi`vZv‡K †mUv Avcbv‡K †`Lv‡Z ejyb) ? (hw` Avcwb †KvbwU ch©‡e¶b K‡i _v‡Kb, Zvn‡j n¨uv =1 , bv =2 ev‡· †KvW Ki“b)|
Ask the respondent: Which of the following are present in the household regardless of place? (If you observe the listed item, write “1” for “yes” in the box below. If you do not observe the listed item, write “2” for “no” in the box below.)
DËi`vZv‡K ‡`Lv‡bvi Rb¨ ej‡Z n‡e|
You should ask the respondent to show you.
Yes (n¨uv) 01
No (bv) 02
mvevb (Bar soap) ((
cvDWvi/wWUvi‡R›U (Detergent powder) ((
Zij mvevb (Liquid soap) ((
QvB (Ash) ((
gvwU/evjy (Mud/Sand) ((
wKQzB †bB (None) ((
Ab¨vb¨, wbw`©ó Kiæb (Other, specify below) ((
__________________________________________
End of Section Four
‡mKkb 5t M„n¯’vjx‡Z aygcvb msµvšÍ cÖkœmg~n
Section 5: Housing structure Smoking Status Questions
5.1 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi N‡ii KvVv‡gv‡Z aygcv‡bi †¶‡Î wb‡Pi †Kvb wbqgwU †ekx cÖ‡hvR¨?
ASK, Which of the following best describes the rules about smoking inside your housing structure?
ev‡´ †KvW wjLyb (Record number in box): ((
me¸‡jv Ackb D”P¯^‡i c‡o †kvbvb
(Read all options out loud)
Avcbvi N‡ii KvVv‡gvi g‡a¨ aygcvb Kivi AbygwZ Av‡Q
Smoking is allowed in your housing structure 01
Avcbvi N‡ii KvVv‡gvi g‡a¨ mvavibZ aygcvb Kivi AbygwZ ‡bB, Z‡e gv‡S gv‡S e¨wZµg N‡U
Smoking is generally not allowed inside of your housing structure but there are exceptions 02
Avcbvi N‡ii KvVv‡gvi g‡a¨ KL‡bvB a~gcv‡bi AbygwZ ‡bB
Smoking is never allowed inside your housing structure 03
aygcv‡bi R‡b¨ Avcbvi N‡i aivevav †Kvb wbqg †bB
There are no rules about smoking in your housing structure 04
Rvwb bv Don't know 99
← hw` 5.1 Gi DËi 3 nqZ ত‡e 6 bs †mKk‡b P‡j hvb If answer to 5.1 is 3 then skip to section 6
5.2 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi N‡ii KvVv‡gvi wfZ‡i mKj i“‡gB wK aygcvb MÖnY‡hvM¨?
ASK, Inside your housing structur is smoking allowed in every room?
--j¶¨ Ki“b: hw` ïaygvÎ GKwU wbw`©ó i“‡g GKRb gvÎ †jv‡KiI a~gcv‡bi AbygwZ _v‡K (†hgb wcZv), wKš‘ Ab¨ †KD (†hgb mšÍv‡biv) †mLv‡b a~gcvb bv K‡i, Zvic‡iI †mB i“‡g a~gcv‡bi AbygwZ i‡q‡Q e‡j Mb¨ Ki‡Z n‡e|
--NOTE: If any person is allowed to smoke inside a particular room for one person (for example, a father), even if other people (for example, the kids) are not allowed to smoke inside that same room, then smoking is allowed in that room.
ev‡´ †KvW wjLyb (Record code in box) ((
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
5.3 DËi`vZv‡K wRÁvmv Ki“b KZ mgq ci ci Avcbvi N‡ii KvVv‡gvi g‡a¨ †KD aygcvb K‡i?
ASK, How often does anyone smoke inside your housing structure?
ev‡´ †KvW wjLyb (Record code in box) ((
‰`wbK Daily 01
mvßvwnK Weekly 02
gvwmK Monthly 03
gvwm‡Ki †P‡q Kg mgq Less than monthly 04
KL‡bvB bv Never 05
bv Rvwb bv Don’t Know 99
End of Section Five
‡mKkb 6: Av_©-mvgvwRK Ae¯’v
Section 6: Socioeconomic Status
6.1 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi খানার (A_ev খানার †Kvb m`‡m¨i) Av‡Q wK? (cÖ‡Z¨KwU †¶‡Î hw` Lvbvi wb‡Pi †h †Kv‡bv AvB‡Ug _v‡K, Z‡e n¨uv =1 , bv =2 ev‡· wjLyb| hw` DËi`vZvi bv Rvbv _v‡K Z‡e ev‡· Ó9”†KvW Ki“b)|
ASK, Does your household (or any member of your household from the Enumeration Form) have: (If the household has the listed item, write “1” for “yes” in the box below. If the household does not have the listed item, write “2” for “no” in the box below, if the respondent does not know, write “9” for “Don’t know” in the box below.)
j¶¨ Ki“b-ïaygvÎ †mB Dcv`vb¸wj AšÍf©y³ Ki“b hv evox‡Z Dcw¯’Z Av‡Q, XvKv wKsev we‡`‡k bq
--NOTE: Include items that are present in bari, not items owned in Dhaka or abroad.
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
a. we`yr (Electricity)? ((
b. Avjgvix (Almirah or wardrobe)? ((
c. †Uwej (A table)? ((
d. ‡Pqvi ev †e (A chair or bench)? ((
e. Nwo (A watch or clock)? ((
f. LvU (Khat)? ((
g. †PŠwK (Chouki)? ((
h. mPj †iwWI (A radio that is working)? ((
i. mPj †UwjwflY (mv`v-Kv‡jv) (A television (B/W) that is working)? ((
j. mPj ‡UwjwflY (iwOb) (A television (Color) that is working)? ((
k. wd«R (A refrigerator)? ((
l. ev&BmvB‡Kj (A bicycle)? ((
m. gUi mvB‡Kj (A motorcycle)? ((
n. †mjvB‡gwkb (A sewing machine)? ((
o. j¨vÛ‡dvb (A land phone)? ((
p. †gvevBj †dvb (A mobile phone)? ((
6.2 ch©‡e¶Y: DËi`vZvi nvDwRs ÷ªvKPv‡ii Qv` ˆZix‡Z wK Dcv`vb e¨envi Kiv n‡q‡Q ?
Observation: Material of the Roof of respondent’s housing structure:
--j¶¨ Ki“b: সবচেয়ে দামী উপাদান লিপিবদ্ধ করুন।
--NOTE: Please record the COSTLIEST material present
ev‡´ †KvW wjLyb (Record code in box) ((
mvavib Qv`Natural roof
KvuPv (evuk/Lo) Katcha (bamboo / thatch) 11
‡gŠwjK Qv` Rudimentary roof
wUb Tin 21
m¤cbœ Qv` (cvKv) Finished roof (pukka)
wm‡g›U/ KswµU/ Uvwj Cement / concrete / tiled 31
(Ab¨vb¨t wb‡P wbw`©ó K‡i wjLyb) Other: Specify below 41
_____________________________________
6.3 ch©‡e¶Y: DËi`vZv nvDwRs ÷ªvKPv‡ii †`qvj ˆZix‡Z c wK Dcv`vb e¨envi Kiv n‡qQ? (ch©‡e¶bK…Z Z_¨ wjwce× Ki“b)
Observation: Material of the walls of the respondent’s housing structure
--j¶¨ Ki“b: সবচেয়ে দামী উপাদান লিপিবদ্ধ করুন।
--NOTE: Please record the COSTLIEST material present
ev‡´ †KvW wjLyb (Record code in box) ((
mvavib ‡`qvj Natural walls
cvU/ evuk/কাদামাটি (KvuPv)
Jute / bamboo / mud (katcha) 11
‡gŠwjK ‡`qvj Rudimentary walls
KvV Wood 21
m¤úbœ ‡`qvj (cvKv) Finished walls
BU/wm‡g›U Brick / cement 31
wUb Tin 32
(Ab¨vb¨t wb‡P wbw`©ó K‡i wjLyb) Other: Specify below 41
__________________________________________________
6.4 ch©‡e¶Y: DËi`vZv nvDwRs ÷ªvKPv‡ii ‡g‡S ˆZix‡Z wK Dcv`vb e¨envi Kiv n‡qQ ?
Observation: Main material of the floor of the respondent’s housing structure
--j¶¨ Ki“b: সবচেয়ে দামী উপাদান লিপিবদ্ধ করুন।
--NOTE: Please record the COSTLIEST material present
ev‡´ †KvW wjLyb (Record code in box) ((
mvavib ‡g‡S Natural floor
gvwU/evuk(KvuPv)Earth / bamboo (katcha) 11
‡gŠwjK ‡g‡S Rudimentary floor
KvV Wood 21
m¤cbœ ‡g‡S (cvKv)Finished floor (pukka)
wm‡g›U/ KswK&ªU Cement / concrete 31
(Ab¨vb¨t wb‡P wbw`©ó K‡i wjLyb)Other: Specify below 41
_________________________________________________
6.5 DËi`vZv‡K wRÁvmv Ki“b - †MvmjLvbv I ivbœvi ¯’vb ev‡` Avcbvi Ggb KZwU i“g Av‡Q hv N‡ii KvVv‡gvi AšÍf~©³?
ASK, Excluding the bathroom and cooking area, how many rooms are there in your housing structure?
--লক্ষ্য করুন: ঘর কি কাজে ব্যবহার হয়, তা জিজ্ঞেস করবেন না। তারা আপনাকে যতোটি রুমের কথা বলে, লিখুন। উত্তরদাতাকে কেবল একটা সংখ্যা জানাতে বলুন।
--NOTE: Do not ask what the rooms are used for. Record the number that they give you. Ask them to give you a number.
-লক্ষ্য করুন: খানার লোকেরা বসবাস করে, শুধুমাত্র ঘরের এমন রুমগুলোকে রুম হিসেবে গন্য করুন। স্টোর রুম বা অন্যান্য রুম যদি ঘরের অন্তর্ভুক্ত হয়, তবে তা গন্য হবে।
--NOTE: Only count rooms that are within the housing structures where household members live. Animal houses are not included. Store rooms or other rooms, that are within the housing structure, are included.
-লক্ষ্য করুন: যদি কমপক্ষে অর্ধেক উচ্চতার দেয়াল হয়, তবে দুটি আলাদা রুম গন্য করুন। নয়তো একটা রুম হিসেবে গন্য হবে।
--NOTE: Count two rooms as separate if the partition that divides them covers >50% of the length of the wall. Otherwise consider as one room.
ev‡´ †KvW wjLyb (Record code in box) ((
6.6 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi N‡i (হাউজিং স্ট্রাকচারে)Nygv‡bvi Rb¨ KZwU iæg Av‡Q?
ASK, How many rooms does your housing structure have for sleeping?
-লক্ষ্য করুন: ৫০% এর বেশি দিন ধরে যদি কোনো রুমে ঘুমানো হয়, তবে তাকে “ঘুমানোর রুম” হিসেবে গন্য করুন।
--NOTE: Count a room as “for sleeping” if it is slept in >50% of days
-লক্ষ্য করুন: jÿ¨ Kiæb: hLb Avcwb †`qv‡ji mvg‡b `uvwo‡qI `yB iæ‡gi ga¨eZx© cvwU©k‡bi Dci w`‡q ‡`L‡Z cvi‡eb bv, ZLbB `ywU iæg wn‡m‡e Mb¨ Ki‡eb|
--NOTE: Count rooms as separate when you cannot see over the partition separating the two rooms while standing in front of partition
ev‡´ †KvW wjLyb (Record code in box) ((
6.7 DËi`vZv‡K wRÁvmv Ki“b - Avcwb †Kvb K¬vk ch©šÍ †jLv-cov K‡i‡Qb? (msL¨vq wjLyb) (hw` DËi`vZvi bv Rvbv _v‡K Z‡e ev‡· Ó99”†KvW Ki“b)|
Ask the respondent: How many years of education have you completed? (record number of years completed below. If “don’t know”, record 99.)
-লক্ষ্য করুন: যদি উত্তরদাতা স্কুলে পড়ে, তবে যেই ক্লাসে পড়ছে সেই সংখ্যাটি লিখুন।উদাহরণস্বরুপ, ক্লাস ০৬ এ পড়লে ৬ লিখুন। এইচএসসি-র জন্যে ১২, ব্যাচেলর ডিগ্রির জন্যে ১৪ এবং মাস্টার্স-এর জন্যে ১৬ লিখুন।
-NOTE: If a respondent is in school, record the number corresponding to their current class number. (For example, for someone in class six, reply “06”. For HSS graduates, record “12”; for Bachelor’s graduates record “14”; for Master’s level record “16”.
ev‡´ †KvW wjLyb (Record code in box) ((
6.8 DËi`vZv‡K wRÁvmv Ki“b - Avcwb wK Lvbvi cÖavb?
Ask the respondent: Are you the head of household?
ev‡´ †KvW wjLyb (Record code in box) ((
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
(6.8 Gi DËi hw` 1 nq, Z‡e cÖkœ bs 6.10 †Z P‡j hvb (If answer to 6.8 is 1, skip to question 6.10)
6.9 DËi`vZv‡K wRÁvmv Ki“b - Lvbv cÖavb †Kvb K¬vk ch©šÍ †jLv-cov m¤úbœ K‡i‡Qb? (wb‡P msL¨vq wjLyb) hw` DËi`vZvi bv Rvbv _v‡K Z‡e ev‡· Ó99”†KvW Ki“b)|
Ask the respondent: How many years of education has the head of household completed? (record number below. If “don’t know”, record 99.)
ev‡´ †KvW wjLyb (Record code in box) ((
6.10 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi Lvbvi wbR¯^ emZwfUv Av‡Q wK?
Ask the respondent: Does your household own homestead land?
ev‡´ †KvW wjLyb (Record code in box) ((
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
(6.10 Gi DËi hw` 2 ev 99 nq, Z‡e cÖkœ bs 6.12 †Z P‡j hvb (If answer to 6.10 is 2 or 99, skip to question 6.12)
6.11 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi Lvbvর †gvU KZUzKz emZভিটা (†Wwm‡gj) Av‡Q? (Rvwb bv n‡j “9999” †KvW Ki“b)
Ask the respondent: How much homestead land does your household own? If “don’t know” code “9999”.
Rwgi †gvU ¯’vbxq GKK Total local land unitt
AMOUNT cwigvb: __________________ SPECIFY UNIT GKK wbw`©ó K‡i wjLyb: _______________
স্থানীয় একক থেকে ডেসিমেল (বিসটিস অফিসে পূরণ করুন)
Conversion from Local Land Unit to Decimals (complete in BISTIS office)
স্থানান্তর রেট: Conversion Rate:
মোট জমির পরিমাণ ডেসিমেলে Total Land in Decimalst
AMOUNT cwigvb: __________________ decimals
6.12 DËi`vZv‡K wRÁvmv Ki“b - emZভিটা Qvov Avcbvi Lvbvর Avi †Kvb Rwg Av‡Q wK?
Ask the respondent: Does your household own any land, other than homestead land?
ev‡´ †KvW wjLyb (Record code in box) ((
Yes (n¨uv) 01
No (bv) 02
Don’t know/Refused to answer (Rvwb bv/ DËi †`‡eb bv) 99
( 6.12 Gi DËi hw` 2 ev 9 nq, Z‡e cÖkœ bs 6.14 †Z P‡j hvb (If answer to 6.12 is 2 or 9, skip to question 6.14)
6.13 DËi`vZv‡K wRÁvmv Ki“b - emZwfUv Qvov Avcbvi Lvbvর wK cwigvb Ab¨vb¨ Rwg (†Wwm‡gj) Av‡Q? (Rvwb bv n‡j “9999” †KvW Ki“b)
Ask the respondent: How much land, other than homestead land, does your household own? If “don’t know” code “9999”.
Rwgi †gvU ¯’vbxq GKK Total local land unitt
AMOUNT cwigvb: __________________ SPECIFY UNIT GKK wbw`©ó K‡i wjLyb: _______________
স্থানীয় একক থেকে ডেসিমেল (বিসটিস অফিসে পূরণ করুন)
Conversion from Local Land Unit to Decimals (complete in BISTIS office)
স্থানান্তর রেট: Conversion Rate:
মোট জমির পরিমাণ ডেসিমেলে Total Land in Decimalst
AMOUNT cwigvb: __________________ decimals
6.14 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi Lvbvq ivbœvi Rb¨ cÖavbZ wK ai‡bi R¡vjvbx e¨envi Kiv nq?
Ask the respondent: What type of fuel does your household mainly use for cooking?
ev‡´ †KvW wjLyb (Record code in box) ((
KvV Wood 01
k‡m¨i Aewkóvsk/Nvm/শুকনো পাতা/পাটের পাতা
Crop residue / grass/dried leaves/jute leaves 02
ïKbv †Mvei Dung cakes 03
Kqjv/KK/wjMbvBU Coal / coke / lignite 04
KvV Kqjv Charcoal 05
‡K‡ivwmb Kerosene 06
we`y¨r Electricity 07
Zij M¨vm/cÖvK…wZK M¨vm Liquid gas / gas 08
ev‡qv-M¨vm Bio-gas 09
Ab¨vb¨, wb‡P wbw`©ó K‡i wjLyb Other, specify below 88
________________________________________________________
Rvwb bv Don’t know 99
6.15 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi Lvbvর Lvevi Rb¨ cvwbi cÖavb Drm Kx?
Ask the respondent: What is the main source of water your household uses for drinking?
ev‡´ †KvW wjLyb (Record code in box) ((
AMfxi wUDeI‡qj Shallow tube well. 01
Mfxi wUDeI‡qj Deep tube well. 02
myiw¶Z cvZK~qv Protected ring/dug well 03
Amyiw¶Z cvZK~qv Unprotected dug well ………………. 04
Zviv cv¤ú Tara pump 05
Av‡m©wbK †kvabvMvi Arsenic free treatment plant 06
myiw¶Z Sbv©i cvwb Water from protected spring … 07
Amyiw¶Z Sbv©i cvwb Water from unprotected spring … 08
f~c„‡ôi cvwbt Surface water
e„wói cvwb Rainwater ……………………………….. 09
U¨vsKvi UªvK Tanker truck ………………………….. 10
†QvU U¨vsKhy³ KvU Cart with small tank ………………… 11
Rxevbygy³Kib cvwbt Pathogen treatment plant (Pond Sand Filter) 12
mivmwi msM„nxZ cvwbt Directly from:
b`x/eva/†jK/cyKzi/†mP bvjv ‡_‡K River/dam/lake/ponds/stream/canal/irrigation channel 13
‡evZjRvZ cvwb Bottled water …………………..…….. 14
N‡ii wfZi U¨vc ev cvB‡ci cvwb Piped water into housing structure ………… 15
DVv‡b U¨vc ev cvB‡ci cvwb Piped water into yard/plot … … 16
cvewjK U¨vc Public tap/stand pipe …………………. 17
Ab¨vb¨, wb‡P wbw`©ó K‡i wjLyb Other: specify below 88
_______________________________________________________________________________________
6.16 AbyMÖnK‡i Avgv‡K †`Lv‡ib wK Avcbviv †Kv_vq cvqLvbv K‡ib ? ch©‡e¶Y: cvqLvbvi aib †iKW© Ki“b|
Say: “Please show me the place where you go to defecate.” Observation: Record type of toilet facility
ev‡´ †KvW wjLyb (Record code in box) ((
DbœZgv‡bi Uq‡jU/ cvqLvbv Improved sanitation facilities:
d¬vk Uq‡jU A_ev cvwb †X‡j d¬vk Kiv Uq‡jU hv cqwb¯‹vkb cvB‡ci mv‡_ ms‡hvM K‡i †`qv
Flush / pour flush to piped sewer system 01
d¬vk Uq‡jU A_ev cvwb †X‡j †mcwUK U¨vs†K hvevi e¨e¯’¨v Av‡Q
Flush / pour flush to septic tank 02
d¬vk Uq‡jU A_ev cvwb †X‡j cvqLvbv wc‡Ui g‡a¨ mwi‡q †`qv hvq Flush / pour flush to pit latrine 03
¯ve mn wcU Uq‡jU /j¨vwUªb Pit latrine with slab 04
AbDbœZgv‡bi Uq‡jU/ cvqLvbv Unimproved sanitation facilities:
d¬vk Uq‡jU A_ev cvwb †X‡j d¬vk Kiv Uq‡jU hv cqwb¯‹vkb cvBc, †mcwUK U¨vsK ev j¨vwUª‡bi mv‡_ ms‡hvRb ‡bB| ( Uq‡jU hv †Kvb Lvj,†Wªb,b`x BZ¨vw`imv‡_ mshy³)
Flush or pour flush toilet not to sewer system, septic tank, or pit latrine (e.g., to canal, ditch,
river, etc.).. 05
wcU j¨vwUªb /Uq‡jU hvi ¯ve †bB(†Lvjv wcU) Pit latrine without slab (i.e., open pit).. 06
SzwoÍ /cvÎ ivLv Bucket 07
SzjšÍ Uq‡jU / cvqLvbv Hanging toilet/latrine… 08
†Lvjv RvqMvq cvqLvbv Open defecation:
‡Kvb cvqLvbv †bB/R½‡j/†Sv‡cSv‡o/gvV No facility/bush/field ………………………………… 09
Ab¨vb¨:( D‡jL Ki“b) others (Specify below) 88
__________________________________________________________________________________
6.17 DËi`vZv‡K wRÁvmv Ki“b - Avcbvi Lvbv e¨vZxZ Avi KZ¸‡jv Lvbv wg‡j GB cvqLvbvwU e¨envi K‡ib ?
Ask the respondent: How many households, other than your own, use this toilet facility?
ev‡´ †KvW wjLyb (Record code in box) ((
6.18 wRÁvmv Ki“b Avcbvi Lvbvi Lv`¨vfvm / Lv`¨ MÖn‡bi aiY Abyhvqx wKfv‡e Avcwb Avcbvi Lvbvi †kªYx weY¨vm Ki‡eb? mviv eQiB wK Lv`¨ Afve _v‡K? KL‡bv KL‡bv Lv`¨ Afve _v‡K, Lv`¨ AfveI _v‡K bv DØ„Ë _v‡K bv,Lv`¨ DØ„Ë _v‡K?
ASK, “In terms of household food consumption, how do you classify your household: deficit the whole year, sometimes deficit, neither deficit nor surplus, surplus?
ev‡´ †KvW wjLyb (Record code in box) ((
mviv eQiB Lv`¨ Afve _v‡K (Deficit the whole year) 01
KL‡bv KL‡bv Lv`¨ Afve _v‡K (Sometimes deficit) 02
Lv`¨ AfveI _v‡K bv DØ„Ë _v‡K bv (Neither deficit nor surplus) 03
Lv`¨ DØ„Ë _v‡K (Surplus) 04
DËi`vZv cªkœ eyS‡Z cv‡I bv Ges †Kvb dËi †`q bv
(Respondent does not understand question and has no response) 33
Rvwb bv/ wbwðZ bB (Don’t know/not sure) 99
ধন্যবাদ। এই অংশটুকু শেষ হয়েছে। Thank you. This part is finished.
এফআরএ কোড এবং স্বাক্ষর Code and signature of FRA:
Ending Time (24-hour format): __ __:__ __
|Checked by: |FRA/FRO/MO Code |Signature |Date (dd/mm) |
|FRA | | | |
|FRO | | | |
|MO | | | |
Appendix 10: Illness Tracking Form (for all ages) Version 18.5.10
Name of Contact: ___________________________________ Is this the Index-Case? (Yes (1) or No (2)): ____
Contact Unique ID___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Age(years)at enrollment: __________________
Date of Call to FRO for Specimen Collection (dd/mm/yy) ___ ___/ ___ ___/ ___ ___ Time (24-hour format) ___ ___: ___ ___
First Day of Illness Tracking (dd/mm/yy): ___ ___/ ___ ___/ ___ ___ Last Day of Illness Tracking (dd/mm/yy): ___ ___/___ ___/___ ___
(ICP ONLY): Date of Second Fever-Free Day (dd/mm/yy): ___ ___/___ ___/___ ___
Mark 1 for “yes”, 2 for “no”, 99 for “don’t know”, for SKIP, “55” for “No household member present”, and for Danger Signs Sections only: “0”for observed danger sign and “3” for reported danger sign
|Day of Observation |
|Fever (If “no”, SKIP to “Other Symptoms”) |
|Cough |
|Cyanosis |
|Chest In-drawing |
|Danger Sign Present ( Called to FRO |
|Missed work/school |
|Hospitalized** | | | | |
|Date of call (dd/mm/yy) | |Time of call (24 hour format) | |
|Household ID# | | | |
|Union / Ward | |Phone number | |
What type of case is this? (
Secondary Case = 1, Follow Up Case = 2, Sick Bari member = 3
Did the possible case or his/her guardian give consent/assent? (
(Yes = 1, No = 2)
Case age ≥18 years, self consent (
(Yes = 1, No = 2)
Case age < 18 years, guardian consent (
(Yes = 1, No = 2)
Case age 7 to < 18 years, self assent (
(Yes = 1, No = 2)
|Date of collection (dd/mm/yy) | |Time of collection (24 hour format) | |
|Age (YY-MM) | | | | |Sex (Male=1; Female=2) | |
If the possible case/guardian did NOT give consent/assent, or specimen wasn’t collected, record why below:
______________________________________________________________________________
______________________________________________________________________________
Code of Medical Officer/Technologist: _____________
Signature: _____________________________________
Date: _________________________________________
BISTIS: Facilitating Tools Tracking Form
Unique ID: __________ Name of Bari Leader: _____________________________________________
evwoi cÖav‡bi bvg
Code of FIS: _____ Name of FIS: _________________________________________________
Bari location evwoi Ae¯’vb: ______________________________________________________________________________________________________
Record Date and Time of FIS visit to bari on DAY ONE: (dd/mm/yyyy) ______________
GdAvBGm-Gi wfwR‡Ui ZvwiL Ges mgq
Complete this section on Day One of intervention.
GB AskwU B›Uvi‡fbk‡bi cÖ_g w`‡b mgvß Ki“b
Write the number of the location in the boxes below: Ae¯’v‡bi msL¨v wb‡Pi ev‡· wjLyb
1 next to cooking area (ivbœvN‡ii cv‡k) 4 Uthaan (DVv‡b)
2 next to toilet area (cvqLvbvi cv‡k) 5 next to tubewell (wUDeI‡q‡ji cv‡k)
3 next to household structure (N‡ii KvVv‡gvi cv‡k) 6 other (write in other location on line below) (Ab¨vb¨, wb‡P wjLyb)
7 not found ( ‡`Lv hvqwb )
1. Site of bari’s handwashing station - must include water and soap □
(evwoi nvZ †avqvi RvqMvi Ae¯’vb -Aek¨B Zvi g‡a¨ cvwb I mvevb _vK‡Z n‡e ):
Other: (Ab¨vb¨: wb‡Pi jvB‡b wbw`©ó K‡i wjLyb)
________________________________________________________________________
2. Site of primary intervention handwashing station (cÖvBgvix B›Uvi‡fbkY nvZ †avqvi RvqMvi Ae¯’vb): □
Other: (Ab¨vb¨: wb‡Pi jvB‡b wbw`©ó K‡i wjLyb)
________________________
3. Site of secondary intervention handwashing station (†m‡KÛvix B›Uvi‡fbkY nvZ †avqvi RvqMvi Ae¯’vb): □
cÖ‡hvR¨ bq (Not Applicable):........................8
(Other: (Ab¨vb¨: wb‡Pi jvB‡b wbw`©ó K‡i wjLyb)
________________________________________________________________________
Number of Bari Members present for intervention on Day 1: _______ children (2-17 years of age) from Bari _______ adults (>18 years of age) from Bari
Complete this section on day one, and all additional days as benefits and barriers are identified.
(GB AskUzKz cÖ_g w`b Ges Ab¨vb¨ AwZwi³ w`‡b c~iY Kiæb hLb myweav Ges Amyweav wPwýZ n‡e)
Benefits of handwashing with soap identified by bari members evwoi m`m¨iv mvevb w`‡q nvZ †avqvi †h ‡h myweav wPwýZ K‡i‡Q
(If bari members mention the listed benefit, write “1” for “yes” in the space. At the END of the Intervention Period, if bari members did not mention the listed benefit, write “2” for “no” in the space. hw` evwoi m`m¨ wb‡gœv³ myweav mg~n wPwýZ K‡i Zvn‡j n¨v Dˇii Rb¨ 1 †KvW wjLyb B›Uvi‡fkb †k‡l †h †h myweav wPwýZ nqwb Zvi R‡b¨ 2 †KvW Ki“b ):
□ 4a. Nurture child or family (cwievi ev wkïi hZœ †bqv)
□ 4b. Be accepted member of society (mgv‡Ri m`m¨ wn‡m‡e MÖnb‡hvM¨Zv)
□ 4c. Reduced diarrhoeal disease (Wvqwiqv Kg nq)
□ 4d. Remove disgusting substances (†bvsiv †_‡K cwi®‹vi _vKv hvq)
□ 4e. Improved health (DbœZ ¯^v¯’¨)
□ 4f. Reduced respiratory illness (k¦v‡mi/Kvwki AmyL Kg nq)
□ 4g. Look, feel, smell clean (cwi®‹vi-cwi”Qbœ †`Lvq Ges fv‡jv †eva nq)
□ 4h. Enhanced social status (mvgvwRK gh©v`v ev‡o)
□ 4i. Soap repels germs ( mvevb Rxevby `~i K‡i)
□ 4j . Write any additional benefits identified below: (Ab¨vb¨ †Kv‡bv myweavi K_v e‡j _vK‡j wb‡P wjLyb)
Identify barriers and solutions of handwashing with soap. Identify those barriers stated by bari members as reasons they find it difficult to wash hands with soap. (If a barrier is mentioned, write “1” for “yes” in the space. At the END of the Intervention Period, if bari members did not mention a barrier, write “2” for “no” in the space.) Identify solution/s that bari members indicate are most appropriate for the stated barrier. (Focus solutions on the most appropriate solution/s, not all solutions.) (If a solution is mentioned, write “1” for “yes” in the space. At the END of the Intervention Period, if bari members did not mention a solution, write “2” for “no” in the space.)
mvevb w`‡q nvZ †avqvi ‡¶‡Î evav Ges Zvi mgvavb wPwýZ Ki“b| evwoi m`m¨iv †h †h Kvi‡Y mvevb w`‡q nvZ ay‡Z mgm¨vi g‡a¨ c‡ib, †m¸‡jv‡K evav wnmv‡e wPwýZ Ki“b (hw` evwoi m`m¨ wb‡gœv³ evav mg~n wPwýZ K‡i Zvn‡j n¨v Dˇii Rb¨ 1 †KvW wjLyb B›Uvi‡fkb †k‡l †h †h evav wPwýZ nqwb Zvi R‡b¨ 2 †KvW Ki“b ) evox m`m¨iv wbw`©ó evavi Rb¨ †h †h mgvavb D‡jL K‡i Zv wPwýZ Ki“b|( me mgvavb bq eis †h mgvavbwU †ewk cÖ‡hvR¨ †mUv‡K †ewk ¸i“Z¡ w`b) hw` evwoi m`m¨ wb‡gœv³ mgvavb mg~n wPwýZ K‡i Zvn‡j n¨v Dˇii Rb¨ 1 †KvW wjLyb B›Uvi‡fkb †k‡l †h †h mgvavb wPwýZ nqwb Zvi R‡b¨ 2 †KvW Ki“b )
□ 5. Not part of routine or habit Solution/s: □ 5a. BISTIS cue cards as reminders wemwUm wKD KvW©
Af¨vm †bB mgvavb □ 5b. BISTIS FIS frequent reminders wemwUm GdAvBGm evievi g‡b Kwi‡q †`qv
□ 5c. Bari leader / elder daily or frequent reminders evwo cÖavb ev e‡qv‡Rô¨ †KD
cÖwZw`b g‡b Kwi‡q †`qv
□ 5d. Teach children now so it becomes habit wkï‡`i GLb †_‡KB wk¶v †`qv hv‡Z Af¨v‡m cwiYZ nq
□ 5e. Place handwashing station in common area in central location mevB e¨envi Ki‡Z cv‡i Ggb ¯’v‡b nvZ †avqvi RvqMv ivLv
□ 5f. Other: Ab¨vb¨: wb†Pi jvB‡b wjLyb| ______________________________________________________
□ 6. Unaware of benefits/lack of knowledge Solution/s: □ 6a. Benefits fact sheet review wemwUm d¨v± wkU cov
Áv‡bi Afve/myweav Rv‡bb bv mgvavb □ 6b. Influenza education flash cards, influenza fact sheet review Bbd¬z‡qÄv
m¤úwK©Z Z‡_¨i wd¬c KvW©, Bbd¬‡qÄv d¨v± wkU cov
□ 6c. BISTIS cue cards for important times review ¸iZ¡c~Y© mg‡qi R‡b¨ wemwUm wKD KvW© wiwfD
□ 6d. Other: Ab¨vb¨: wb†Pi jvB‡b wjLyb|
______________________________________________________
□ 7. Too much energy / laziness Solution/s: □ 7a. Place handwashing station in common area in central location
AZ¨waK PÂjZv ev AjmZv mgvavb mevB e¨envi Ki‡Z cv‡i Ggb ¯’v‡b nvZ †avqvi RvqMv ivLv
□ 7b. Benefits fact sheet review: handwashing can improve health, save more time and energy d¨v± wkU wiwfD: nvZ ay‡j ¯^v¯’¨ fv‡jv _v‡K, mgq Ges kw³ euv‡P|
□ 7c. Benefits fact sheet review: handwashing steps take only a few seconds
d¨v± wkU wiwfD: nvZ ay‡Z gvÎ K‡qK †m‡KÛ mgq jv‡M
□ 7d. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 8. Soap costs too much Solution/s: □ 8a. Benefits fact sheet review: soap costs little, can improve health,
mvev‡bi LiP AZ¨waK †ewk mgvavb people can work more to earn more when they’re healthier
d¨v± wkU wiwfD: mvev‡bi `vg Kg, GwU ¯^v¯’¨ fv‡jv iv‡L, my¯’¨ gvbyl ‡ewk KvR K‡i d‡j †ewk DcvR©Y K‡i|
□ 8b. FIS will give soap when needed for handwashing for 2 weeks hLb cÖ‡qvRb, ZLb GdAvBGm `yB mßv‡ni R‡b¨ nvZ †avqvi mvevb w`‡Z cv‡i|
□ 8c. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 9. Won’t prevent illness Solution/s: □ 9a. Influenza education flash cards, benefits fact sheet review
mvevb †iv‡Mi nvZ †_‡K euvPvq bv mgvavb Bbd¬z‡qÄv welqK wk¶vi wd¬c KvW©, d¨v± wkU wiwfD
□ 9b. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 10. Ash or mud cleans Solution/s: □ 10a. Barriers and solutions fact sheet review: ash & mud may not
QvB ev Kuv`v A`„k¨ Rxevby `~i K‡i mgvavb clean invisible germs
cÖwZeÜKZv Ges mgvavb d¨v± wkU wiwfD: QvB Ges Kuv`v cwi®‹vi K‡i bv|
□ 10b. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 11. Water by itself cleans Solution/s: □ 11a. Barriers and solutions fact sheet review: water alone may not
cvwb wb‡R †_‡KB A`„k¨ Rxevby `~i K‡i mgvavb clean invisible germs
cÖwZeÜKZv Ges mgvavb d¨v± wkU wiwfD: ïay cvwb Rxevby cwi®‹vi K‡i bv|
□11b. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 12. Too busy / no time Solution/s: □ 12a. Place handwashing station in common area in central location
AZ¨waK e¨¯ÍZv/mg‡qi Afve mgvavb mevB e¨envi Ki‡Z cv‡i Ggb ¯’v‡b nvZ †avqvi RvqMv ivLv
□ 12b. Benefits fact sheet review: handwashing can improve health, more time and energy for daily tasks
d¨v± wkU wiwfD: nvZ ay‡j ¯^v¯’¨i DbœwZ nq, ˆ`bw›`b Kv‡Ri R‡b¨ mgq Ges kw³ euv‡P
□ 12c. Benefits fact sheet review: handwashing steps take only a few seconds
d¨v± wkU wiwfD: nvZ ay‡Z gvÎ K‡qK †m‡KÛ mgq jv‡M
□ 12d. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 13. Soap will be stolen Solution/s: □ 13a. BISTIS soap box can protect soap from animals and crows
mvevb Pzwi n‡q hvq mgvavb wemwUm mvev‡bi ev‡·i Kvi‡Y KvK ev Ab¨ cÖvbx mvevb wb‡Z cvi‡e bv|
□ 13b. Take soap in at night to prevent theft iv‡Z Pzwii nvZ †_‡K evP‡Z mvevb N‡i ivLv
□13c. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 14. No handwashing station/too far away Solution/s: □ 14a. BISTIS handwashing station will be given to keep in bari
nvZ †avqvi †Kv‡bv RvqMv †bB ev A‡bK `~‡i mgvavb wemwUm nvZ †avqvi ¯’vb evwo‡Z †`‡e
□ 14b. Place handwashing station in common area in central location mevB e¨envi Ki‡Z cv‡i Ggb ¯’v‡b nvZ †avqvi RvqMv ivLv
□14c. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
_____________________________________________________
□ 15. Don’t care about handwashing Solution/s: □ 15a. Barriers and solutions fact sheet review: handwashing with soap
with soap mgvavb can improve health, save cost of medicine / clinic visits
mvevb w`‡q nvZ †avqv `iKvix g‡b Kwi bv cÖwZeÜKZv Ges mgvavb d¨v± wkU wiwfD: mvevb w`‡q nvZ a~‡j ¯^v¯’¨ fv‡jv _v‡K, Jla ev wPwKrmvi LiP euv‡P
□ 15b. Barriers and solutions fact sheet review: handwashing with soap may prevent illness, more time to work or spend in fields
cÖwZeÜKZv Ges mgvavb d¨v± wkU wiwfD: mvevb w`‡q nvZ a~‡j †ivM cÖwZ‡iva nq, †¶‡Z ev KvR Kivi Rb¨ †ewk mgq cvIqv hvq|
□ 15c. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 16. Forget to wash hands with soap Solution/s: □ 16a. Place handwashing station in common area in central location
mvevb w`‡q nvZ a~‡Z fz‡j hvb mgvavb mevB e¨envi Ki‡Z cv‡i Ggb ¯’v‡b nvZ †avqvi RvqMv ivLv
□ 16b. BISTIS cue cards as reminders wemwUm wKD KvW
□ 16c. Benefits fact sheet review: handwashing can improve health, more time and energy for daily tasks
d¨v± wkU wiwfD: nvZ ay‡j ¯^v¯’¨i DbœwZ nq, ˆ`bw›`b Kv‡Ri R‡b¨ mgq Ges kw³ euv‡P
□ 16d. Benefits fact sheet review: handwashing steps take only a few seconds
d¨v± wkU wiwfD: nvZ ay‡Z gvÎ K‡qK †m‡KÛ mgq jv‡M
□ 16e. Other: Ab¨vb¨, wb‡Pi jvB‡b wjLyb
______________________________________________________
□ 17. Write any additional barriers and solutions identified below: GQvovI †Kv‡bv AwZwi³ cÖwZeÜKZv ev mgvavb _vK‡j wb‡P wjLyb|
COMPLETE NEXT SECTION DAILY DURING INTERVENTION. Yes = 1 No = 2
wb‡Pi AskwU cÖwZw`b B›Uvi‡fbk‡bi mgq c~iY Ki“b| nu¨v = 1, bv = 2
|Age-specific case definitions for index case-patients:|Patient > 5 years |Patient < 5 years |Date of onset |
| | | |(dd-mm-yy) |
|(Yes=1, No=2, Don’t Know = 9) |Yes / No |Yes / No |Approximate time of onset |
| | | |(00:00 24-hour format) |
|8. Fever? | | | |
| | | |9. Date: __ __/__ __/__ __ |
| | | | |
| | | |10. Time: __ __ : __ __ |
| | | | |
| | | |11. MO: Did onset occur within the last 48 hours? Yes (1)/ |
| | | |No(2) |
|12. Cough? | | | |
| | | |13. Date: __ __/__ __/__ __ |
| | | | |
| | | |14.Time: __ __ : __ __ |
| | | | |
| | | |15. MO: Did onset occur within the last 48 hours? Yes (1)/ |
| | | |No(2) |
|16. Sore throat? | | | |
| | | |17. Date: __ __/__ __/__ __ |
| | | | |
| | | |18. Time: __ __ : __ __ |
| | | | |
| | | |19. MO: Did onset occur within the last 48 hours? Yes (1)/ |
| | | |No(2) |
| 20. Does the patient meet | | |21. Comment (if any): |
|age-specific case definition? | | | |
| |
| |
|Instruction: If the patient meets the case definition, then consider him/her a ‘suspected index case-patient’ and ask questions below under “Additional inclusion |
|criteria”; otherwise thank the patient and stop the interview at this point. |
| |
|The age-specific case definitions for index case-patients are: |
|Persons≥ 5 years old: Influenza-like illness (ILI), defined as history of fever, and either cough or sore throat with onset within the last 48 hours. |
|Persons < 5 years old: any child with acute fever with onset within the last 48 hours |
|Additional inclusion criteria |
| |
| |
|22. Has any other resident in your household had fever during the past 7 days? |
|(yes=1, no = 2, don’t know = 9) |
| |
|(If yes, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below.|
|If no, then continue. |
| |
|22a. Has any other resident in your bari had fever during the past 7 days? |
|(yes=1, no = 2, don’t know = 9) |
| |
|(If no or don’t know, SKIP to Question 23. If yes, proceed to Question 22b. |
| |
|22b. Who had fever and for how many days did s/he have fever? |
|1. Name/Relation: _______________________ Days of fever (1-7, don’t know=99) ________ |
|2. Name/Relation: _______________________ Days of fever (1-7, don’t know=99) ________ |
|3. Name/Relation: _______________________ Days of fever (1-7, don’t know=99) ________ |
| |
|(If any bari member had fever for 2 or more days out of the last 7 days, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question |
|‘Does the patient meet the additional inclusion criteria’ below. If bari members(s) had fever for only 1 day or the patient does not know the duration of |
|fever, then continue. |
|23. Does the patient live within 30 minutes of either UHC or JIMCH? (Yes = 1, No = 2) |
| |
|(If no, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below. |
|If yes, then continue. |
| |
|24. Which upazilla do you live in? Bajitpur = 1/Kuliachar = 2/Others = 8 |
| |
|If other then please specify ___________________________________________ |
| |
| |
|25. Will you be living in your bari during the next 20 days? (yes=1, no = 2) |
| |
|(If no, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below. |
|If yes, then continue. |
| |
|26. Will 2 or more other persons be living in your bari during next 20 days? (yes=1, no = 2) |
| |
|(If no, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below. |
|If yes, then continue. |
| |
| |
|27. Was the patient previously enrolled in our study? (yes = 1, no = 2) |
| |
|(If yes, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below.|
|If no, then continue. |
| |
| |
| |
|28. Patient order for hospitalization and was hospitalized? (yes = 1, no = 2) |
| |
|(If yes, patient is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below.|
|If no, then continue. |
| |
|29. Patient ordered for admission but refused admission (yes=1, no=2) |
|(If yes (patient refused admission), then eligible and continue |
|is ineligible, SKIP the remaining questions and record ‘No’ for the question ‘Does the patient meet the additional inclusion criteria’ below. If yes, then |
|continue. |
|30. Does the patient meet the additional inclusion criteria? (yes=1, no = 2) |
| |
|31. Have you received a vaccination for influenza or Swine Flu/H1N1 in the past six months? |
|(Yes=1, No=2) |
|Possible Treatments: |
|32. Is the patient being treated with medications for the symptoms indicated above? (Yes=1, No=2) |
| |
|If no, skip following section |
|What medications is the patient being treated with? List below |
| |
|33. Name of the Drug |34. Was the patient prescribed the|35. Code of the Drug |36. Has the patient begun|
| |drug? |(Couldn’t mention Drug name = |treatment with the drug? |
| |(Yes = 1, No = 2) |999) |(Yes = 1, No = 2) |
| | | | |
| | | | |
| | | | |
| | | | |
PCR Specimen Collection Section
37. Unique ID #
| | | | |
|38. Time Sample collected (24 hour | |
|format): |Time: __ __ : __ __ |
Signature of Medical Officer:___________________________ Date: ___________________
Appendix 15a: VENTILATION ASSESSMENT FORM: SLEEPING ROOM
Note: Complete one ventilation assessment form for each room where a particle monitor is placed.
Household ID: (((((((( Date: ___ /___/___ FRA code: (((
1. Measure the dimensions of the room in centimeters. Width (centimeters): __________________ Length (centimeters): __________________
2. How many people of any age sleep there: (( 3. How many children < 5 years old sleep there: ((
4. How many hours during the 24 hours the AQM was present in the room was the ceiling fan turned on (record 99 for “NA”): ((
5. How many hours during the 24 hours the AQM was present in the room was the table fan turned on (record 99 for “NA”): ((
6. Drawing Instructions: Using the symbols below, indicate the locations of stoves or burners, existing windows, doors, ventilators, indoor walls, index case-patient’s bed, and the particle monitoring device. The wall on which the particle monitor is placed should be drawn as the top wall on the diagram.
Stove/Burner Window Door Ventilators Indoor Wall Study Child’s Bed AQM
CF TF
Ceiling Fan Table Fan
Appendix 15b: VENTILATION ASSESSMENT FORM: COOKING AREA
ONLY TO BE ASSESSED IN BARIS WITH FULLY ENCLOSED KITCHENS
Note: Complete one ventilation assessment form for each room where a particle monitor is placed.
Household ID: (((((((( Date: ___ /___/___ FRA code: (((
1. Measure the dimensions of the room in centimeters. Width (centimeters): __________________ Length (centimeters): __________________
2. How many people use this cooking area: ((
3. How many hours during the 24 hours the AQM was present in the room was the ceiling fan turned on (record 99 for “NA”): ((
4. How many hours during the 24 hours the AQM was present in the room was the table fan turned on (record 99 for “NA”): ((
5. Drawing Instructions: Using the symbols below, indicate the locations of stoves or burners, existing windows, doors, ventilators, indoor walls, and the particle monitoring device. The wall on which the particle monitor is placed should be drawn as the top wall on the diagram.
Stove/Burner Window Door Ventilators Indoor Wall Particle Monitor Ceiling Fan
Table Fan
Appendix 16: Consent Form: Follow Up Study Enrollment for Bari
Protocol Number: 2009-004
Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Follow Up Study
Investigator’s name: Dr. Eduardo Azizz-Baumgartner
Organization: ICDDR,B
Introduction
In 2009, your Bari took part in a research study about influenza. The research study was conducted by scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University at Buffalo, a university in the USA. We are now here to talk with you about a second part of that study. We would like to understand household practices and illness experiences of members of your bari.
Purpose of the research
We are trying to how household practices can change over time and how these practices may affect certain illnesses, like diarrhea and respiratory illness.
Why selected
Your Bari took part in the first part of our study last year. This second part is being completed only in baris that were enrolled in the first part of the study.
What is expected from the members of your Bari?
If you agree to enrolling your Bari in the study:
I will visit your bari to observe your bari’s household practices three times over the next three or four months.
At two of the visits, I will speak to the person who came to the Jahurul Islam Medical College Hospital with influenza or another respiratory illness in (month) 2009. If that person was a child under 15 years old, I will speak to his/her parent or guardian. I will ask some questions about household practices. I will also make some quick observations of your bari at each of the visits. At one of the visits, I will also sit in the uthaan for about 90 minutes to observe your bari’s household practices.
During these visits I will also ask each member of your bari if they have had symptoms of fever, respiratory illness, or gastrointestinal illness, in the previous 48 hours.
(Following paragraph to be read aloud if SmartSoap will be used in the bari.)
During one of the visits, I will give your bari a bar of special Lifebuoy soap to use for three days, after which I will return to collect the bar of soap two days later. The special Lifebuoy soap is almost the same as Lifebuoy soap available in the market and provides the same benefits. You will likely not be able to tell the difference between the special and regular soap. The special Lifebuoy soap should be used as soap is usually used in your bari. The special Lifebuoy soap that we are giving you has an electronic device that collects information on soap use. People who are sensitive to Lifebuoy soap or who experience skin reactions to Lifebuoy soap will experience similar reactions to the Lifebuoy soap that we are giving you and should not use it.
Also at the third visit, I will ask two members of your bari to give me their mobile numbers. I will thereafter call that person twice per week for six months to determine if any of the members of your bari have a fever.
After the third visit, for those people who have a fever, we will ask them to allow us to take a nose and throat swab; one of our trained research personnel will have to place a swab into their nose and a different swab into their throat.
Risk and benefits
The process of having someone visit your home may be uncomfortable to you. However, we do not expect any harm to come to you or your family because of being visited.
(Following paragraph to be read aloud if SmartSoap will be used in the bari.)
In people who have skin reactions to Lifebuoy soap available in the market, the special Lifebuoy soap may cause similar skin reactions. These people should not use the Lifebuoy soap that we give you. The Lifebuoy soap that we are giving you has a battery in it. The battery is like batteries that are used in watches and cameras. The battery is protected inside a case within the soap. It is very unlikely that you will see the battery. If you do see the battery case within the soap, you may continue to use the soap normally. Please try to remember on which day you saw the case sticking out through the soap. As with any soap, please do not allow children to put it into their mouths.
All Baris that take part in the study will receive the benefit of bars of soap; however, there will be no other immediate benefits. However, this study will help us better understand if handwashing behavior can change over time. It will also help us understand if handwashing behavior is related to respiratory illness and diarrhea.
For those people who have symptoms and who allow us to take a nose and throat swab, one of our trained research personnel will have to place a swab into their nose and a different swab into their throat. This may be uncomfortable. There are no other known risks for this procedure.
The results of the test will not alter in any way the treatment of the person who has symptoms and, thus, the results will not be given to the person who has symptoms.
Privacy, anonymity and confidentiality
All of the information we collect about the members of your community will be kept private and confidential. We will keep all data in a locked cabinet. We will not give any information about your community to anyone not involved in the study.
Future use of information
If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy.
Right not to participate and withdraw
You may choose to allow your Bari to take part or not to take part in this study. You may refuse to take part at any time. You may also withdraw your Bari from the study at any time. Refusal to participate or withdrawal from the study will involve no penalty or loss of benefits for the members of your community at the clinic or hospital. Even if you do not enroll your Bari in the study, everyone in your Bari will still receive the usual care at the clinic. Each individual in your Bari may choose to participate or not participate, and may choose to withdraw from the study at any time.
Principle of compensation
There is no cost to you or your bari for participation in this study. Other than receiving free soap, you will not receive any compensation for being in the study.
Persons to Contact:
If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact:
Dr. Eduardo Azizz-Baumgartner, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 250025, 01711697962
If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact:
Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989
If you agree to enrolling your Bari in our study, please indicate that by putting your signature or your left thumb impression at the specified space below.
Thank you for your cooperation.
_______________________________________ ____________________
Signature or left thumb impression of subject Date
_______________________________________ ____________________
Signature or left thumb impression Date
of attendant/Guardian
_______________________________________ ____________________
Signature or left thumb impression of the witness Date
_______________________________________ ___________________
Signature of the PI or his/her representative Date
Appendix 17: Follow Up Bari Eligibility Form
1. Index case ID: __ __ __ __
2. FRA code: __ __ __
First Visit
3. Date of first visit (dd/mm/yy) ___/ ___/ ___
|4. Did bari enrollment occur? | |
|Yes (1) No (2) | |
|(If ‘yes’, skip remaining questions | |
|5. Why did bari enrollment not occur? | |
| | |
|No adults present to sign consent form………………….1 | |
|Head of bari would not sign consent form………………2 | |
|Unable to find bari members…………………………….3 | |
|Other, specify below…………………………………….8 | |
| | |
|__________________________________________________________ | |
Second Visit
6. Date of second visit (dd/mm/yy) ___/ ___/ ___
|7. Did bari enrollment occur? | |
|Yes (1) No (2) | |
|(If ‘yes’, skip remaining questions | |
|8. Why did bari enrollment not occur? | |
| | |
|No adults present to sign consent form………………….1 | |
|Head of bari would not sign consent form………………2 | |
|Unable to find bari members…………………………….3 | |
|Other, specify below…………………………………….8 | |
| | |
|__________________________________________________________ | |
To be answered after completion of follow up study (or before depending on drop out date):
|9. Did the household decide not to participate at some point during the follow up study? | |
|Yes (1) No (2) | |
|(If ‘yes’, explain why below) | |
|10. Explanation of household drop out: |
| |
| |
| |
|11. Date of drop out (dd/mm/yyyy):_____/______/_______ |
Appendix 18: BISTIS Follow Up Survey Form
1. Ask the respondent: Name of Respondent: _______________________
2. How is the respondent related to the index case?
Record code in box.
Self…………………………….…………... 1
Parent/Guardian..…………………………………. 2
Fellow bari member………………………. 3
3. Respondent (Index case/ Guardian/ Bari member) Unique ID# (Taken from enumeration form) ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
4. Index Case Patient Unique ID# ___ ___ ___ ___
5. Follow Up Visit Number (1, 2, or 3 ): ______
6. Follow Up Visit Date (dd/mm/yy): ___/___/______
7. FRA code ___ ___ ___
Section One: HAND WASHING STATION QUESTIONS
Ask: “Can you please show me where you most often wash your hands?”
8. Observation: Is there a designated place for hand washing?
(Record number in box):
Yes……………………………………………….1
No..…………………………..………………….2 ( If the answer to question 8 is “no”, skip to question 12
9. Observation: Is the BISTIS intervention handwashing container present at the bari handwashing place?
(Record number in box):
Yes………………………………………………. 1
No..………………………………………………. 2
10. Observation: Is water present at the bari handwashing place?
(Record code in box) (You must actually see water to record “yes”):
Yes………………………………………………. 1
No..………………………………………………. 2
11. Observation of items present at the handwashing place (Look for each items individually and please do not prompt)
(If you observe the listed item, write “1” for “yes” in the box below.
If you do not observe the listed item, write “2” for “no” in the box below.)
Bar soap (
Detergent (powder) (
Liquid soap (
Ash (
Mud/Sand (
Other cleansing agent, specify (
_____________________________________________
12. Ask: Can you show me any items used in your household for washing hands?
(If the respondent can show you the item within one minute after s/he goes to get it write “1” for “yes” in the box below.
If you do not observe the listed item within one minute after the respondent goes to get the item, write “2” for “no” in the box below. Do NOT prompt)
Bar soap (
Detergent (powder) (
Liquid soap (
Ash (
Mud/Sand (
Other, specify below (
______________________
13. Observe: Are intervention cue cards visible in the bari?
(Record number in box)):
Yes 1
No 2 ( If the answer to question 13 is “yes”, skip to section 2
Show the respondent an example of the BISITS Intervention Cue Cards.
14. Ask the respondent: “Last year, did anyone give your bari cards that looked like this?
(Record number in box)):
Yes 1
No 2 ( If the answer to question 14 is “no”, skip to section 2
15. Ask the respondent: “Can you please show me the cards?” Record whether or not the respondent can show you the BISTIS Intervention Cue Cards. (Record number in box)):
Yes 1
No 2
Section Two: STRUCTURED OBSERVATION
16. Record: Is this the first follow up visit at the bari?
(Record number in box):
Yes 1
No 2( If the answer to question 16 is “no”, skip to section three
16. Record which household is to be observed.
Record number in box
Index case household 1
Head of bari household 2
Secondary household 3
17. Record: Total no. of members of household to be observed (if this is ICP household, include ICP): ______
18. Record Number of members of household to be observed present at the time of observation
(if this is ICP household, include ICP if present): ______________
19. Record the number of individuals in the household to be observed
Record number in boxes
Children < 5 (( 2.0 Children ≥ 5 to < 18 (( 2.1 Persons ≥ 18 ((
Say to the respondent: “I would like to stay with you until about current time plus 2.5 hours. I would only like to observe and will not interrupt. If that would be okay now, you may please continue with your normal daily routine. After about 1.5 hours I will ask some people in the bari some questions.”
20. Time of beginning observation (24 hrs): hh:mm ((:((
21. Time of ending observation (24 hrs): hh:mm ((:((
Comments: ______________________________________________________________
__________________________________________________________________________
Section 2. Observation of Hand Wash Opportunities and Behaviors
| | | |
|Line # |Exposure: |Time of observation |
| |Before preparing | |
| |/serving food 1 |24-hours time |
| | | |
| |Before eating 2 |(hh:mm) |
| | | |
| |After cleaning child’s | |
| |bottom/nappy 3 | |
| | | |
| |After using the toilet 4 | |
| | | |
| |After coughing / sneezing 5 | |
| | | |
| |After blowing or wiping own | |
| |nose 6 | |
| | | |
| |After blowing or wiping | |
| |child's nose 7 | |
| | | |
| |If the hands get visibly soiled... 9 | |
| | | |
| |Others: Specify 8 | |
|Sneeze or cough into shoulder/elbow | | |
|Sneeze or cough into sleeve/sari | | |
|Sneeze or cough into hands | | |
|Sneeze or cough the air | | |
|Wash his/her hands with soap and water (type of soap need not be specified) | | |
|Time action is done or said (24-hour format): ___:___ | | |
|Wash hands with ash/mud/sand and water (use or mention of ash/mud/sand and water, but not soap) | | |
| Time of washing hands with water but not soap (24 hour format) ___:___ | | |
|Wash hands with water only (use or mention of water but not soap) | | |
|Time action is done or said (24-hour format): ___:___ | | |
|Wash hands with ash/mud/sand/cloth but no water (no use or mention of water or soap) | | |
|Time action is done or said (24-hour format): ___:___ | | |
27. Observe: Did the index case patient/guardian/respondent actually wash hands with at least water within the 5 minutes after coughing?
(Record number in box):
Yes 1
No 2 ( If the answer to question 20 is “no”, skip to section 3
28. Observe: Did the index case patient/guardian/respondent use any of the following when s/he washed his/her hands within the 5 minutes after coughing?
(If the index case patient/guardian/respondent used the item, write “1” for “yes” in the box below.
If the index case patient/guardian/respondent did NOT use the item, write “2” for “no” in the box below.)
Bar soap (
Detergent (powder) (
Liquid soap (
Ash (
Mud/Sand (
Other, specify below (
______________________
Section Four: HAND WASHING DEMONSTRATION – Cleaning child after defecation
If ICP is < 5years then demonstration should be done with him/her. If ICP is > 5years then look for any < 5 years child in ICP’s household. If no < 5 years child present in ICP’s household then ask the respondent: “Can you bring me to the mother or other primary caregiver of the youngest child who lives in your bari?” If the primary caregiver of the youngest child is not present, ask about the primary caregiver of the next youngest child, until you are able to identify a primary caregiver who is present during the interview time
29. Is there any ................
................
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